Elsevier

The Knee

Volume 13, Issue 3, June 2006, Pages 177-183
The Knee

Review
A systematic review of lateral wedge orthotics—how useful are they in the management of medial compartment osteoarthritis?

https://doi.org/10.1016/j.knee.2006.02.003Get rights and content

Abstract

Studies on the use of lateral wedge orthotics in the conservative management of medial compartment osteoarthritis are widely quoted. This approach, however, does not consider the disruption of the interaction between lower limb and foot and ankle function that lateral wedges would produce. This comprehensive, systematic review was therefore undertaken to evaluate all available literature to determine whether evidence exists to support their use. MEDLINE, EMBASE, CINAHL, Allied and Complimentary Medicine, PubMed, EBSCO HOST and PEDro, Abstracts of Reviews of Effects in the National Electronic Library for Health for Cochrane Reviews and manual searching were used to identify studies. ClinicalTrials.gov was searched for trials in progress. Data extraction was performed by the three authors using a paper data extraction form which was based on the CONSORT statement and Critical Skills Appraisal Programme (CASP) guidelines. Overall, the results of this review suggest that, based on current evidence there are no major or long-term beneficial effects with the use of lateral wedges.

Introduction

In 1987 Yasudi and Sasaki [1], [2] published, in English, two papers suggesting the biomechanical and clinical advantages of lateral wedging as a conservative treatment for medial compartment osteoarthritis (MCOA). These papers are widely quoted: EULAR recommendations for the management of Knee Arthritis [3], Osteoarthritis: New Insights: Part 2: Treatment Approaches [4] and in Conferences with Patients and Doctors in JAMA [5]. A Cochrane Review [6] of braces and orthoses for treating OA knee has recently been completed. Cochrane Reviews have stringent quality criteria for selection of articles which is usually helpful. However in this case, it eliminated many of the most frequently quoted sources of evidence for lateral wedges including the first two papers named above.

Given the importance of the knee varus torque in the progression of medial compartment osteoarthritis (MCOA), the use of an in-shoe lateral wedge to reduce this torque constitutes a seemingly logical conservative treatment [7]. However, the complexity of lower limb function might be further disrupted by the use of a lateral wedge which would inhibit normal foot and ankle biomechanics. A comprehensive, systematic review was therefore undertaken to evaluate all available literature to determine whether evidence exists to support the use of lateral wedges.

Section snippets

Types of studies

As the number of studies available was limited, all were considered eligible if they investigated the use of lateral wedges either biomechanically or clinically in a normal or in a patient population. Studies which included subtalar elastic strapping [8], [9], [10], [11], [12] were not included as this strapping was applied in such a way as to encourage supination and inhibit pronation which has the opposite effect to lateral wedging. In addition, the sub-talar strap may provide sensory

The mechanics of treatment of the osteoarthritic knee with a wedged insole. Yasuda and Sasaki [1]

The mechanical effects of standing on a wedged board while balancing on one leg were examined. The results state that putting a wedge under the foot will alter the angle of that limb with the supporting surface but no other clear findings emerge.

Methodological quality 2bC

Application of a lateral heel wedge as a nonsurgical treatment for varum gonarthrosis. Giffin et al. [21]

This study evaluated the effect of the use of a 12.5-mm heel wedge tapering to 6.35 mm at the forefoot worn in shoes both statically and dynamically. It was found that there were no statistical differences in linear parameters

Discussion

In the 19 years since the publication of the two Japanese trials the rigor and standards of clinical trials have changed and what was previously considered an acceptable study may not meet the tighter specifications required today. In addition, the applicability of the Japanese studies to a more general population is questionable. Racial differences in gait and foot type have been considered significant by diverse authors [32], [33].

The X-ray results indicated that the use of lateral wedges does

Acknowledgements

This paper forms part of a PhD thesis of the first author who has received a grant from ARC to help fund her studies.

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    • Comparison the effect of lateral wedge insole and acupuncture in medial compartment knee osteoarthritis: A randomized controlled trial

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      Citation Excerpt :

      Some of the previous studies obtained good results for lateral wedge prescription and found much benefit including decrease in VAS score, femorotibial angle and talar tilt angle in patients with knee OA with varus deformity [13], reducing the varus torque [19,21], reducing loading of the medial compartment in persons with medial knee osteoarthritis [19] and reducing the knee adduction moment [12] and walking pain in a large group of patients with medial knee OA [12]. In contrast to the abovementioned advantages and our results, a systematic review conducted by Reilly et al. [22] in 2006 could not find major or long-term beneficial effects with the use of lateral wedges. In 2007 Baker et al. [6] conducted a double-blind, randomized, crossover trial that participants received a 5° lateral-wedge insole or a neutral insole for six weeks.

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