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