Sunday, May 22, 2011
Wedge insoles (foot orthoses) fail to help osteoarthritis of the knee
New research has revealed knee osteoarthritis patients who placed wedge insoles in their shoes daily for 1 year had no benefit in pain or function, compared with control patients. These and other data appear to rule out the efficacy of wedge insoles for osteoarthritis (OA). A randomized, controlled trial of 179 osteoarthritis patients was carried out by a team of researchers. The finding means that knee osteoarthritis (OA) treatment recommendations from the European League Against Rheumatism (EULAR) and from the Osteoarthritis Research Society International (OARSI) need revision. In the Melbourne study, the researchers used full-length wedges and MRI to assess structural outcomes. The study recruited patients (aged 50 years and older) from the community who had knee pain on walking over the medial region with medial osteophytes and joint narrowing, a mechanical axis of 182 degrees or less, and a Kellgren-Lawrence (KL) grade of 2 or 3. The 200 patients who entered the study averaged 64 years old, about 60% were women, their average symptom duration was 7 years, their average body mass index was about 29 kg/m Every day, the randomized patients placed in their shoes either a wedge insole with a 5-degree pitch, or a flat, fully compressible control insole. Treatment ran for 1 year, with the insoles replaced quarterly. Patients in the wedge group reported wearing their insoles for an average of 7 hours daily, whereas the controls used theirs for an average of 9 hours daily. The study's primary outcomes (assessments of pain and cartilage structure) showed no significant differences between the 89 patients who completed 1 year in the wedge group and the 90 control patients who finished 1 year. The two groups also had no significant differences in measures of function. The main difference between the treatment groups was that 47% of wedges users and 23% of controls self-reported problems with the insoles. Reports of foot pain came from 36% of wedge users and 16% of controls. The discomfort was rated as severe by 10% of wedge users and 1% of controls.