Effects of footwear on medial compartment knee osteoarthritis
| Autor: | Sulabha Masih, Meika A. Fang, Kaly Kao, Karen L. Perell, Connie E. Taylor, Aksone Nouvong |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Male
musculoskeletal diseases medicine.medical_specialty WOMAC Visual analogue scale Pilot Projects Osteoarthritis Physical medicine and rehabilitation Subtalar joint medicine Humans Outpatient clinic Aged business.industry Rehabilitation Osteoarthritis Knee musculoskeletal system medicine.disease Gait Shoes medicine.anatomical_structure Knee pain Joint pain Physical therapy Female medicine.symptom business human activities |
| Zdroj: | The Journal of Rehabilitation Research and Development. 43:427 |
| ISSN: | 0748-7711 |
| Popis: | This pilot study investigated whether lateral-wedge insoles inserted into shock-absorbing walking shoes altered joint pain, stiffness, and physical function in patients with symptomatic medial compartment knee osteoarthritis (OA). Twenty-eight subjects wore full-length lateral-wedge insoles with an incline of 4[degrees] in their walking shoes for 4 weeks. Pain, stiffness, and functional status were measured with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at baseline and 4 weeks postintervention. Significant improvements were observed in all three WOMAC subscales (pain, stiffness, and function). Pain scores were significantly reduced for the most challenging activity--stair climbing. Subjects wore insoles daily and tolerated them well. The results of this study indicated that lateral-wedge insoles inserted into shock-absorbing walking shoes are an effective treatment for medial compartment knee OA. Key words: functional status, knee, lateral-wedge insoles, orthoses, osteoarthritis, pain, rehabilitation, shock-absorbing shoes, stair climbing, stiffness, varus. INTRODUCTION Knee osteoarthritis (OA) is a disease common in older adults that can result in significant disability because of pain, stiffness, and loss of joint motion. Current treatment is aimed at minimizing pain, maintaining or improving joint mobility, and decreasing functional impairment. Although the pathogenesis of knee OA is not well understood, biomechanical stresses that affect the articular cartilage and subchondral bone have been implicated as important inciting factors [1-3]. During the midstance phase of gait, about 60 to 80 percent of the load is distributed through the medial compartment of the normal knee [4], which is one of the reasons knee OA frequently involves the medial compartment. Varus angulation deformity may occur in medial compartment knee OA and contribute to the progression of OA by causing increased load to the medial knee compartment, with subsequent damage to the articular cartilage and subchondral bone in that area [5]. Clinicians have used surgical wedge osteotomy for many years to correct varus angulation by shifting weight away from the diseased knee compartment [6]. An alternative nonoperative approach has been to realign the weight-bearing load through footwear modification. Shoe modifications, such as lateral-wedge insoles or shock-absorbing shoes with insoles, have been recommended for conservative therapy of mild knee OA [7-8]. Little objective data exist, however, regarding the effects of lateral-wedge insoles on clinical parameters such as pain and functional status in patients with symptomatic medial compartment knee OA [9-10]. One randomized controlled study showed that subjects with medial compartment knee OA decreased nonsteroidal anti-inflammatory drug (NSAID) intake when they wore bilateral lateral-wedge insoles but did not report any change in pain, stiffness, or function as measured by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index [11]. Women with medial compartment knee OA who wore bilateral lateral-wedge insoles with elastic strapping of the subtalar joint had a significant decrease in femorotibial angle and visual analog scale (VAS) score for subjective knee pain and an improvement in Lequesne index scores (a measure of disease severity) [12]. These changes were not observed in women who wore traditional shoe-inserted lateral-wedge insoles. A lateral-wedge insole reduces peak knee varus torque, external varus moment, and lateral thrust in patients with knee OA, which may be some of the mechanisms by which this insert reduces pain in knee OA [13-15]. In this uncontrolled pilot study, we investigated the short-term effects of full-length lateral-wedge insoles combined with shock-absorbing shoes on pain and function in the treatment of symptomatic medial compartment knee OA. METHODS Subjects Twenty-eight community-dwelling individuals (mean age [+ or -] standard deviation [SD] = 67 [+ or -] 11 yr) who fulfilled American College of Rheumatology criteria [16] for knee OA were recruited for this study through flyers distributed in outpatient clinics of the Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System and community newspaper advertisements. … |
| Databáze: | OpenAIRE |
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