| Osteoarthritis (OA) is the most common form | | | | the ankle, resulting in slight correction of |
| of arthritis and affects approximately 30 | | | | the varus knee deformity. Measures that many |
| million Americans. The underlying pathology | | | | studies have included are subjective daytime |
| is altered biochemical changes in cartilage- | | | | pain, night time pain, length of time |
| the gristle that caps the ends of long bones. | | | | required to walk 50 feet, and reduction in |
| Cartilage consists of cells called | | | | need for non steroidal anti-inflammatory |
| chondrocytes that produce a matrix. The | | | | drugs. Different types of wedges are |
| chondrocytes sit inside this matrix, much | | | | available. Some wedges are simply inserted |
| like grapes inside gelatin. With the | | | | inside a shoe. Other wedges come with a strap |
| development of OA, the chondrocytes no longer | | | | that provides stability of the wedge inside |
| function properly. In addition, inflammatory | | | | the shoe. According to one of the authors |
| changes occur within the joint. The end | | | | responsible for the development of a popular |
| result is progressive and gradual loss of | | | | wedged insole device, "The prevalence of knee |
| cartilage- leading to altered mechanics. Pain | | | | OA in our society is increasing due to the |
| develops as a result of a number of factors | | | | escalating proportion of elderly persons. A |
| including inflammation of the lining of the | | | | conservative therapy such as the use of an |
| joint, stimulation of pain receptors in the | | | | insole that provides a low-cost complement or |
| joint capsule, and stretching of ligaments | | | | alternative to surgical treatment would be a |
| and tendons due to the altered biomechanics. | | | | very useful adjunct to the care of patients |
| While, OA tends to affect weight-bearing | | | | with knee OA and would benefit the health |
| joints such as the neck, low back, hips, and | | | | economy." [Toda Y and Tsukimura N. Randomised |
| knees, the area that seems to be responsible | | | | trial to compare the clinical effects of an |
| for most visits to a rheumatologist's office | | | | insole with subtalar strapping and knee |
| is OA of the knee. Conservative OA of the | | | | support with hinged struts for patients with |
| knee treatment consists of a comprehensive | | | | varus deformity osteoarthritis of the knee. |
| program incorporating patient education, | | | | Arthritis Rheum 2004; 50 (9) (supplement). |
| weight loss, exercise, | | | | Toda Y and Tsukimura N. A six-month follow-up |
| non-steroidal-anti-inflammatory drugs, | | | | of a randomised trial to compare the efficacy |
| glucocorticoid (cortisone injections), and | | | | of a lateral wedge insole with subtalar |
| viscosupplementation (injections of lubricant | | | | strapping and an in-shoe lateral wedged |
| material). In a previous article, I discussed | | | | insole in patients with varus deformity |
| the use of bracing for OA of the knee, which | | | | osteoarthritis of the knee. Arthritis Rheum |
| is another conservative measure. In this | | | | 2004; 50 (9) (supplement)]. While some |
| article I discuss a little-known but very | | | | detractors point to flaws in study design, |
| effective means of reducing knee pain called | | | | abundant anecdotal evidence as well as the |
| the lateral wedge insole. Lateral wedged | | | | multiplicity of studies pointing towards |
| insoles are aimed at patients with varus | | | | effectiveness, suggest that these insoles |
| deformity knee OA. A varus deformity means | | | | should at least be given a try. |
| the patient has "bow-legs". Patients with | | | | |
| varus knee deformities due to OA have | | | | Nathan Wei, MD FACP FACR is a rheumatologist |
| significant pain involving the medial | | | | and Director of the Arthritis and |
| (inside) part of the knee. A number of | | | | Osteoporosis Center of Maryland. He is a |
| studies have demonstrated that the use of the | | | | Clinical Assistant Professor of Medicine at |
| lateral wedge insole, by lifting the outside | | | | the University of Maryland School of |
| of the foot, leads to valgus angulation of | | | | Medicine. |