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