ORIGINAL RESEARCH ARTICLE

Combined Effects of a Valgus Knee Brace and Lateral Wedge

Insole on Walking in Patients with Medial Compartment
Knee Osteoarthritis
Fatemeh Mirzaei, MSc, Mokhtar Arazpour, PhD, Roshanak Baghei Roodsari, PhD, Mahmood Bahramizadeh, PhD, Mohammad Ali Mardani, PhD

ABSTRACT
Introduction: The use of a valgus knee brace and a lateral wedge foot orthosis in patients with knee osteoarthritis (OA) has been
reported as a novel treatment strategy. The purpose of this study was to analyze the combined effect of laterally wedged inlay and
knee brace on walking in volunteer subjects with medial compartment OA.
Materials and Methods: Eighteen subjects with symptomatic medial compartment knee OA participated in this study. Based on
the treatment strategies, all subjects were divided into three groups: (1) lateral wedge insole, (2) valgus knee brace, and (3) both
knee brace and foot orthosis. A Vicon digital motion capture system using eight cameras at a frequency of 100 Hz and two force
platforms were used to capture data.
Results: In the lateral wedge group, a significant difference was observed in the knee adduction moment (KAM) with and with-
out condition. In the valgus brace group, there was a significant difference in KAM, speed of walking, cadence, and knee joint
range of motion (ROM) with and without intervention. In the valgus brace plus lateral wedge insole group, there was a signif-
icant difference in KAM and hip, knee, and ankle joints ROM.
Conclusions: The concurrent use of valgus knee brace and lateral wedge insole can produce a greater overall reduction in the
KAM. The use of two types of orthoses, both separately and combined, did not improve the speed of walking, step length, and
hip, knee, and ankle joints ROM in the affected side. (J Prosthet Orthot. 2018;30:39–45)
KEY INDEXING TERMS: valgus knee brace, lateral wedge insole, walking, medial compartment knee osteoarthritis, kinematics
and kinetics

K
nee osteoarthritis (OA) is a degenerative joint disease in the development and progression of the disease state.1 The
that leads to the degradation of articular cartilage in knee joint OA has been shown to develop in approximately 10%
the knee joint. Individuals with OA have pain and stiffness of adults older than 55 years.2 Prevalence of knee OA in the me-
due to change in the structure of the cartilage and narrowing of dial compartment is 5 to 10 times higher than disease in the
the joint space. These mechanical factors play an important role lateral compartment.3 The suggested reason for this fact is ap-
proximately 60% of load passes through the medial side of the
knee during ambulation.4
FATEMEH MIRZAEI MSc and MOKHTAR ARAZPOUR, PhD, are affili- Medial compartment OA is more prevalent than lateral com-
ated with the Pediatric Neurorehabilitation Research Center, University partment disease due to the mechanism of load distribution in
of Social Welfare and Rehabilitation Sciences, Tehran, Iran. normal walking. Approximately 60% of the total load passes
MOKHTAR ARAZPOUR, PhD, is affiliated with the Iranian Research through the medial compartment of the knee in normal sub-
Center on Aging, University of Social Welfare and Rehabilitation Sci- jects, leading to further degenerative changes with medial com-
ences, Tehran, Iran. partment type. This results in the mechanical load passing more
FATEMEH MIRZAEI, MSc, MOKHTAR ARAZPOUR, PhD; MAHMOOD medially through the knee than normal.4,5 Pain, immobility,
BAHRAMIZADEH, PhD, MOHAMMAD ALI MARDANI, PhD, and disability, a reduced quality of life, and negative changes in ki-
ROSHANAK BAGHAEI ROODSARI, PhD, are affiliated with the Depart- netic and kinematic parameters are the symptoms of medial
ment of Orthotics and Prosthetics, University of Social Welfare and compartment OA.6,7
Rehabilitation Sciences, Tehran, Iran. Treatment options for knee OA consist of operative and non-
FATEMEH MIRZAEI, MSc, is affiliated with the Student Research Com- operative approaches. Operative treatment includes arthroscopy,
mute, University of Social Welfare and Rehabilitation Sciences and Knee joint replacement, and osteotomies. Nonoperative methods are
and Sport Medicine Research Center, Milad Hospital, Tehran, Iran. often prescribed (indicated) in mild to moderates stages or when
Disclosure: The authors declare no conflict of interest. surgery is not feasible. These nonoperative treatments consist of
Copyright © 2017 American Academy of Orthotists and Prosthetists. drug therapy, physiotherapy, and orthotics conservative treat-
Correspondence to: Mokhtar Arazpour, PhD, Department of Orthotics ments.8 The overall aim of the conservative treatment of OA is to
and Prosthetics, University of Social Welfare and Rehabilitation Sci- reduce pain, improve functioning, and reduce disease progression
ence, Kodakyar St., Daneshjo Blvd, Evin, Tehran, 1985713834, Iran; rates.9 In orthotic conservative treatment, these methods aim to
email: [email protected] reduce the externally applied knee adduction moment (KAM)

Volume 30 • Number 1 • 2018 39

Copyright © 2017 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited.
Arazpour et al. Journal of Prosthetics and Orthotics

acting on the medial aspect of the knee. The use of laterally METHODS
wedged insoles and specifically designed knee braces is a common
conservative method to treat medial compartment knee OA.10 SUBJECTS
Lateral wedges change the position of the center of pres- The study included 18 subjects with varus alignment, symp-
sure by redirecting it more laterally to reduce the KAM.11,12 tomatic medial compartment knee OA, and those prescribed for
A study reported that a 5° inclined lateral wedge-type insole a conservative treatment, who were referred to the Department
significantly reduced the KAM.13 Other studies demonstrated of Orthotics and Prosthetics in the University of Social Welfare
the ineffectiveness of a 5° lateral wedge in reducing the external and Rehabilitation Sciences. Radiological evaluation combined
KAM.14–16 On comparing the different lateral wedges with 3°, 5°, with reported knee symptoms associated with radiological eval-
6°, and 10° inclinations, it was found that a 6° lateral wedge uation were used to diagnose knee OA. The inclusion criteria for
reflected the minimum correction angle proven to be effective by this study included localized pain in the medial side of the
previous studies.13,17 tibiofemoral joint, greater joint space narrowing on the medial
Knee braces can be divided into four classes, consisting of side compared with the lateral side, and the existence of medial
prophylactic, functional, rehabilitative, and valgus off-loader compartment knee OA of Kellgren-Lawrence grade 2 or 3 con-
knee braces. These knee braces are a common nonsurgical strat- firmed by radiological examination. Anteroposterior radiographs
egy for treating people with medial knee OA.18 Knee braces have of the hip-to-ankle joints in the standing position were used to
also been shown to decrease the net adduction moment applied evaluate alignment of the knee joint in the frontal plane. A me-
by the ground reaction force by applying a constant abduction chanical axis angle of ≥1° varus in the knee joint was considered
(valgus) moment closer to the knee joint center.10 Previous stud- as varus alignment. Kellgren-Lawrence grades were also detected
ies have reported that the wearing of knee braces reduced the load according to the full-length standing radiographs. The exclusion
on the medial compartment for ambulation19 and increased con- criteria for this study included arthroscopic surgery in the past
fidence in loading and the ability to push off vertically.20 6 months; knee trauma and lower-limb amputation; neurological
The use of valgus knee brace and lateral wedge foot ortho- disease; symptomatic spine, hip, ankle, and foot disease; intra-
sis has been reported as a novel treatment strategy for knee articular steroid injection in the past 3 months; hyaluronic acid
OA. According to a study, the separate evaluation of valgus injection in the last 9 months; previous fracture of the tibia; skin
knee braces, lateral wedge foot orthoses, and variable stiffness disease; peripheral vascular disease; blindness; severe cardiovas-
shoes decreased the external KAM.21 On using a knee brace, cular defect; and an inability to apply a brace (due to arthritis in
the position of the knee joint center changed in the medial di- the hand or difficulty in bending). Signed consent forms were ob-
rection. However, the use of a lateral wedge insole altered the tained from all the study participants. The ethics committee of
orientation of the ground reaction force in the lateral direc- the University of Social Welfare and Rehabilitation Sciences ap-
tion. Therefore, there might be a possibility of additive effects proved the performance of this study.
on reducing the KAM when these interventions are used to- TESTING PROTOCOL
gether. Moyer et al.22 evaluated the combined effect of knee The orthotic devices were fitted to the patients' body, and
orthosis and lateral wedge insole on 16 medial compartment
they were advised to wear the devices for 2 weeks (8 hours per
knee OA patients and reported that the use of knee brace
day) immediately before the time of the initial formal biome-
and foot orthosis at the same time can produce a greater over-
chanical evaluation. The usage of these devices was properly
all reduction in the KAM.
checked by researcher via telephone in this study. The 2-week
Despite the current evidence, studies evaluating the combined
period was considered sufficient to verify the wearing compli-
effect of the knee braces and inlays compared with the effective-
ance and permit adequate acclimation to the brace and insole.
ness of knee orthoses or inlays in treating knee OA are scarce.
The orthotic devices were worn bilaterally in the patients having
Therefore, additional research is required to demonstrate their bilateral knee pain. Three different groups were considered in
effectiveness on the kinetics and kinematics of the lower limb.
this study: (1) lateral wedge insole (no intervention, with interven-
Accordingly, the primary objective of this proof-of-concept
tion), (2) valgus knee brace (no intervention, with intervention),
study was to test the hypothesis of using two different mecha-
and (3) both knee brace and foot orthotic (no intervention, with in-
nisms (direct force and indirect force) for correcting the knee
tervention). Block randomization was used to achieve the same
valgus position so as to decrease the external KAM during gait
number of K/L grade 2 versus 3 ratios in each of the 3 groups.
when used simultaneously. The secondary objective was to ex-
plore the changes in the walking parameters (temporal-spatial, VALGUS KNEE BRACE
kinetic, and kinematic) in the medial compartment knee OA. All subjects were fitted with a custom-fit valgus knee brace by
Therefore, the purpose of this present study was to analyze an experienced orthotist before the gait analysis was performed.
and compare the combined effects of the two orthotic treatment The knee orthosis was fabricated on a 3-point bending mecha-
strategies, laterally wedged inlay or a knee brace, on certain pri- nism to provide a medially directed force to the lateral aspect
mary outcome measures in volunteer subjects with medial com- of the knee joint. The components of the knee brace were in-
partment OA. The primary outcome measures are knee pain, cluded in the hard shell cuff around the thigh and shank, with
KAM, lower-limb sagittal plane kinematics, the speed of walk- medially placed hinge and lateral crossover strap. The casting
ing, and cadence and step length. of the lower limb was performed in the weight-bearing

40 Volume 30 • Number 1 • 2018

Copyright © 2017 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited.
Journal of Prosthetics and Orthotics Valgus Knee Brace and Lateral Wedge Insole

condition for each subject, and the casted mold was sent to the lateral condyle of the femur, head and lateral malleolus of the
brace manufacturer. The knee brace was constructed as per the fibula, the second metatarsal, anterior superior iliac spine, and
casted mold that was custom fit and adjustable. This orthosis calcaneus. The following parameters were analyzed: knee pain
was set to vary at 4° and 7° valgus angles. The orthotist asked levels (using the visual analog scale), sagittal plane hip, knee
the subjects to walk in the clinic and then adjusted the knee and ankle joints range of motion (ROM), maximum externally
valgus angle as per the comfort level of the patients. The sub- applied KAM, walking speed, cadence, and step length. The
jects were advised to wear the knee orthosis while performing means of the resulting data were calculated from both left and
their daily activities. right sides for the five walks using each device.
The external adduction moment about the knee was calcu-
LATERAL WEDGE FOOT ORTHOSIS lated by using inverse dynamics. Each lower-limb segment (foot,
shank, and thigh) was modeled as a rigid body with a local coor-
Full-length lateral wedge foot orthoses were made from a
dinate system that coincided with anatomically relevant axes. In-
cork composite (Thermocork; Aetrex Worldwide, Inc, Teaneck,
ertial properties of each limb segment were approximated
NJ) with a density of 60 durometers. An experienced orthotist
anthropometrically, and translations and rotations of each seg-
fitted the wedges to each subject during standing, walking,
ment were reported relative to neutral positions defined during
and while wearing the valgus knee brace. The orthotist initially
the initial standing static trial. For each trial, the KAM waveform
evaluated the subjective influences of the lateral wedges using
was normalized to body weight and height (%BW*Ht) and
two prefabricated full-length lateral wedges of 6 and 10 mm.
inspected visually. The peak magnitudes of the external KAM
The purpose of having a maximum lateral wedge height was to
in the first and second halves of stance were identified using
provide comfort to the subject. The foot orthosis with no wedge
an algorithm that identified values immediately preceded by a
was used for the nonaffected side. All subjects in the test condi-
minimum of 5 continuously ascending values and followed by
tions were fitted with a pair of comfortable, identically styled
a minimum of 5 continuously descending values.
lightweight shoes pitched with a 1-inch heel height. Figure 1
demonstrates the valgus knee orthosis and lateral wedge insole
SUBJECTIVE ASSESSMENT
used in this study.
Before the biomechanical evaluations, the patients were
GAIT ANALYSIS evaluated regarding the quality of orthoses fitting and com-
For each patient, gait analysis was conducted under two con- fort. A visual analog scale (VAS) ranging from 0 (“no pain”)
ditions in the baseline and after 2 weeks of wearing the conser- to 10 (“worst pain imaginable”) was also used for pain assess-
vative devices. Five walking trials were considered for each ment when walking.
condition. A Vicon digital motion capture system (Oxford Met-
rics, United Kingdom), using eight cameras (Vicon, Infrared) DATA ANALYSIS
at a frequency of 100 Hz, and two force platforms set apart and Because of the normality of data (which was confirmed
positioned to capture a left and right heelstrike (Kistler 9286BA, using the Kolmogorov-Smirnov technique), a paired t test
Switzerland) were used for capturing data. Fourteen markers was used for comparing the outcome measures of the inter-
were placed bilaterally over the position of the greater trochanter, group comparison. The univariate analysis was used for

Figure 1. Valgus knee orthosis (left side) and lateral wedge insole (right side) used in the study.

Volume 30 • Number 1 • 2018 41

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Arazpour et al. Journal of Prosthetics and Orthotics

Table 1. Subjects demographic information who participated in this study

Lateral Wedge Insole Valgus Brace Valgus Brace Plus Lateral Wedge
No. Subjects 6 6 6 P
Age (yr) 54.50 (4.23) 55.16 (4.81) 53.17 (6.18) 0.085
Sex (female) 83.3% 50.0% 66.7% 0.162
Body mass index (kg/m2) 24.74 (2.46) 27.92 (5.40) 26.77 (0.51) 0.444
Mechanical axis angle of the knee joint (degree) 5.5 (1.87) 5.83 (1.47) 5.61 (1.64) 0.930
Pain at rest (VAS, 0–100) person-based 44.00 (19.69) 49.66 (24.60) 47.33 (22.30) 0.538
Kellgren-Lawrence grading scale for the dominant leg (II) 33.3% 33.3% 33.3% 1.000
(III) 66.7% 66.7% 66.7%

analyzing the efficacy of the intragroup comparison. SPSS statis- there was a significant difference in KAM and hip, knee, and an-
tical software was used for analysis of the data. The level of signif- kle joints ROM. There was no significant difference in the speed
icance was set at 0.05. of walking, cadence, and step length between with and without
intervention.

RESULTS INTRAGROUPS COMPARISON AND MEAN (SD) OF

The baseline data showed no significant differences in the THE MENTIONED PARAMETERS IN BASELINE
means of the age, sex, body mass index, or knee OA grade be- The comparison between lateral wedge insole group and
tween the randomly assigned test groups (Table 1). The two valgus brace group revealed a significant difference in knee
groups were therefore appropriately similar to facilitate the joint ROM. There was no significant difference in residual
comparison of the primary outcome measures. In addition, mentioned parameters (eg, pain, KAM, speed of walking, step
Table 2 demonstrates the mean (SD) of the mentioned parameters length, cadence, ankle joint ROM, and hip joint ROM). The
in the three test conditions with and without interventions. comparison between lateral wedge insole group with valgus
Table 3 shows the intergroup and intragroup comparison of brace plus lateral wedge group showed a significant difference
the mentioned parameters in this study. in KAM, step length, speed of walking, and knee joint ROM.
There was no significant difference in pain, cadence, ankle joint
INTERGROUPS COMPARISON AND MEAN (SD) OF ROM, and hip joint ROM. The comparison between valgus brace
MENTIONED PARAMETERS IN BASELINE group and valgus brace and lateral wedge group showed a signif-
A significant difference was observed between with and with- icant difference in KAM.
out interventions of lateral wedge insole with respect to KAM in
the lateral wedge group. There was a statistically significant dif-
ference favoring with and without interventions of the valgus
brace group and were noted for the KAM, speed of walking, ca- DISCUSSION
dence, and knee joint ROM. There was no significant difference The results of this study provide the concept of using a valgus
in step length and hip and ankle ROM with and without inter- knee brace and lateral wedge concurrently to enhance the mag-
vention. In the valgus brace plus lateral wedge insole group, nitude of decrease in the KAM.

Table 2. Mean (SD) of mentioned parameters in the three test conditions with and without interventions

Lateral Wedge Insole Valgus Brace Valgus Brace Plus Lateral Wedge
Preintervention Postintervention Preintervention Postintervention Preintervention Postintervention
Speed (m/s) 0.980 (0.105) 0.951 (0.157) 0.804 (0.258) 0.682 (0.264) 0.855 (0.270) 0.617 (0.139)
Cadence (stride/min) 49.55 (3.91) 47.43 (6.66) 46.75 (5.84) 41.81 (6.97) 47.70 (8.13) 41.36 (3.22)
Step length (m) 0.586 (0.042) 0.599 (0.028) 0.508 (0.117) 0.478 (0.133) 0.524 (0.092) 0.449 (0.084)
Hip ROM (degree) 45.25 (5.39) 44.68 (6.31) 42.63 (6.64) 40.66 (4.85) 43.53 (2.02) 38.71 (4.47)
Knee ROM (degree) 62.28 (5.53) 59.61 (5.31) 53.00 (12.23) 44.78 (8.47) 56.98 (11.60) 44.33 (6.95)
Ankle ROM (degree) 29.31 (4.67) 26.83 (4.04) 24.08 (2.60) 24.53 (2.34) 33.05 (4.01) 28.08 (4.98)
Pain (VAS) 44.00 (19.69) 22.50 (13.20) 49.66 (24.60) 24.16 (12.90) 47.33 (22.30) 18.50 (6.65)
KAM First Peak 3.41 (0.73) 2.95 (0.8) 3 (0.7) 2.41 (0.49) 3.25 (0.61) 2.36 (0.54)
(%BW*Ht)
Second Peak 2.80 (0.76) 2.33 (0.6) 2.25 (0.55) 1.76 (0.5) 2.46 (0.47) 1.63 (0.25)
(%BW*Ht)

42 Volume 30 • Number 1 • 2018

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Journal of Prosthetics and Orthotics Valgus Knee Brace and Lateral Wedge Insole

Table 3. Intergroup and intragroup comparison of mentioned parameters in this study

Intragroup Comparison* Intergroup Comparison**

P1 P2 P3 P4 P5 P6
Speed (m/s) 0.508 0.011 0.073 0.264 0.029 0.817
Cadence (stride/min) 0.142 0.021 0.120 0.548 0.301 1.000
Step length (mm) 0.326 0.059 0.112 0.419 0.045 0.738
Hip ROM (degree) 0.464 0.182 0.035 1.000 0.084 0.476
Knee ROM (degree) 0.060 0.038 0.001 0.002 0.000 0.546
Ankle ROM (degree) 0.061 0.662 0.014 1.000 1.000 0.477
Pain (VAS) 0.043 0.024 0.010 1.000 1.000 1.000
KAM First Peak (%BW*Ht) 0.000 0.013 0.000 0.445 0.02 0.045
Second Peak (%BW*Ht) 0.007 0.002 0.001 0.168 0.001 0.019

*Paired t-test analysis.

**Univariate analysis.
P value 1: Intragroup comparison between preintervention and postintervention in subjects with lateral wedge insole.
P value 2: Intragroup comparison between preintervention and postintervention in subjects with valgus brace.
P value 3: Intragroup comparison between preintervention and postintervention in subjects with lateral wedge insole and valgus brace.
P value 4: Intergroup comparison between lateral wedge insole group and valgus brace group.
P value 5: Intergroup comparison between lateral wedge insole group and valgus brace plus lateral wedge group.
P value 6: Intergroup comparison between valgus brace group and valgus brace plus lateral wedge group.

Three different teams of investigators have considered the combined. The use of valgus knee brace reduced the hip, knee,
combined effects of knee braces and foot orthotics on walking and ankle joints ROM, and the step length. Therefore, the speed
parameters in medial compartment knee OA. While evaluating of walking reduced with immediate effect of the wearing condi-
the combined effect of the rigid ankle foot orthoses and lateral tions. Compared with other knee OA participants in published
wedge insole in healthy subjects, Schmalz et al.23 reported studies, the cohort in this study exhibited relatively slow gait
changes in the KAM during walking. Moyer et al.22 evaluated speed (the preintervention gait speed ranged from 0.804 to
the combined effect of the knee brace and orthotic foot inlay 0.980 m/s). All participations were grade 3 and 4 medial com-
on medial compartment knee OA and showed a reduction in partment knee OA in this study. The severity of cartilage com-
the KAM. In a recent randomized crossover trial, Hunter et al.24 promise and resultant knee pain may explain the slow speed of
evaluated the combined effect of wearing a valgus knee brace, the subjects' ambulation. Schmalz et al.23 found that the mean
neutral foot orthosis, and motion control shoe. Their results walking speed significantly increased from 1.27 m/s (without
showed significant improvement in knee pain that was more brace) to 1.36 m/s (with orthosis). Gaasbeek et al.25 demon-
than the placebo treatment. Despite their positive effects, the strated that patients with a valgus unloader brace walked at a
valgus unloader braces are also found to be associated with some faster pace. In addition, Arazpour et al.26 found that the
functional disadvantages. They can cause a significant reduction speed of walking in baseline was 0.90 m/s, and after 6 weeks
in knee flexion during the swing phase. This restriction can re- of brace usage, it increased to 1.08 m/s. Pagani et al.27
sult in reduced foot clearance and a shorter stride.20,25 showed that the average walking speeds in test conditions
The use of orthosis and lateral wedge separately and in com- without an orthosis, with 4° valgus angulation and a neutral
bination has been found to reduce step length as an immediate flexible test condition were 1.45 ± 0.15, 1.47 ± 0.12, and
effect after the wearing condition. The patients did not undergo 1.45 ± 0.14 m/s, respectively.
long accommodation time after wearing the two interventions. The quality of life improvement of subjects with OA is consid-
Only 2 weeks of wearing the orthoses was considered for this ered important. However, the main aim of this conservative ap-
study. Similar to our study, Gaasbeek et al.25 reported the nega- proach (combined knee orthosis and lateral wedge) is to reduce
tive effects of knee braces on step length and stride length. They the load in one knee compartment that would further decrease
demonstrated a decrease in the duration of the swing phase, the disease progression. Although the separate use of lateral
which would explain the decreased step and stride length during wedge and valgus knee orthosis have shown to efficiently de-
walking with a brace. In contrast with our study, Schmalz et al.23 crease the subjective pain, their combined use has not been eval-
reported an increased value from 0.71 m (without brace condi- uated in their study.28 The findings of the present study provide
tion) to 0.73 m (with orthosis) while the step length of the con- evidence that pain reduction and improvement of the function
tralateral limb reduced from 0.75 to 0.73 m. are not necessarily associated with a decrease in joint load. It
Table 2 presents the speed of walking on immediately wear- seems that long-term wearing of these two interventions to-
ing the lateral wedge and valgus knee brace, separately and gether can be effective for pain relief.

Volume 30 • Number 1 • 2018 43

Copyright © 2017 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited.
Arazpour et al. Journal of Prosthetics and Orthotics

STUDY LIMITATIONS 5. Krohn K. Footwear alterations and bracing as treatments for knee
The main limitation of this study could be the small sample osteoarthritis. Curr Opin Rheumatol 2005;17(5):653–656.
size. This present study, being a pilot study, will lead to further 6. Raja K, Dewan N. Efficacy of knee braces and foot orthoses in
research with a large sample size. No control group was declared conservative management of knee osteoarthritis: a systematic
without any intervention in this study. In addition, the patients review. Am J Phys Med Rehabil 2011;90(3):247–262.
with only grade 2 and 3 OA were included in the study. Apart 7. Bejek Z, Paróczai R, Illyés Ã, et al. Gait parameters of patients with
from this, the long-term effects of using this intervention model osteoarthritis of the knee joint. Facta Universitatis-Series: Physical
should be analyzed. Education and Sport 2006;4(1):9–16.
Not controlling for gait speed in the preintervention and 8. Schmalz T, Knopf E, Drewitz H, Blumentritt S. Analysis of
postintervention gait assessments is a major concern that may biomechanical effectiveness of valgus-inducing knee brace
potentially invalidate the study findings. Slowed gait speed will for osteoarthritis of knee. J Rehabil Res Dev 2010;47(5):
reduce knee moments and ROM, as evidenced in data presented 419–429.
in Table 2; hip, knee, and ankle ROM all decreased and KAM de- 9. Brouwer R, Jakma T, Verhagen A, et al. Braces and orthoses for
creased. It is impossible to disentangle whether the KAM and treating osteoarthritis of the knee. Unicompartmental Osteoarthritis
ROM reductions were a result of the biomechanical benefits of of the Knee 2006:37.
the orthoses or slower gait speed. Future study in this field with
10. Maleki M, Arazpour M, Joghtaei M, et al. The effect of knee
this goal will be beneficial.
orthoses on gait parameters in medial knee compartment
osteoarthritis: a literature review. Prosthet Orthot Int 2016;40:
CONCLUSIONS 193–201:0309364614547411.
The patients with medial compartment knee OA showed 11. Yasuda K, Sasaki T. The mechanics of treatment of the
lower walking velocity, reduced knee ROM, decreased cadence, osteoarthritic knee with a wedged insole. Clin Orthop Relat Res
reduced step length and stride length, and increased peak varus 1987;(215):162–172.
moments about the knee during the stance phase of walking in 12. Self BP, Greenwald RM, Pflaster DS. A biomechanical analysis of a
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This study demonstrated that the use of either laterally Care Res 2000;13(4):191–197.
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13. Kerrigan DC, Lelas JL, Goggins J, et al. Effectiveness of a
prove knee pain in subjects with medial compartment knee OA,
lateral-wedge insole on knee varus torque in patients with
but the combined wearing of these interventions was not more
knee osteoarthritis. Arch Phys Med Rehabil 2002;83(7):
effective in decreasing the pain compared with the separate
889–893.
using of the lateral wedge and knee orthosis in this study. The
findings of the present study showed that the use of valgus knee 14. Baker K, Goggins J, Xie H, et al. A randomized crossover trial of a
brace and lateral wedge insole can produce a greater overall re- wedged insole for treatment of knee osteoarthritis. Arthritis
duction in KAM. The observed results demonstrated that wear- Rheum 2007;56(4):1198–1203.
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ACKNOWLEDGMENT
knee osteoarthritis. Clin Biomech (Bristol, Avon) 2002;17(8):
We would like to thank the University of Social Welfare and Rehabilita- 603–610.
tion Sciences for the financial support in this study.
17. Kakihana W, Akai M, Yamasaki N, et al. Changes of joint moments
in the gait of normal subjects wearing laterally wedged insoles. Am
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