Simple wedges worn inside shoes could help reduce the pain of knee arthritis. Three trials are currently under way in the U.S. to test the ability of specially shaped wedges to realign the knee and redistribute loads and pressures from everyday activities.
Earlier research showed they might have a significant effect on symptoms of osteoarthritis of the knee and ankle. In some cases, patients have been able to reduce their dosage of painkillers and have become more active after using the devices, known as in-shoe wedged orthoses.
When a knee develops osteoarthritis, the cartilage lining gradually roughens and becomes thin. The surrounding bone reacts by growing thicker, and the bone at the edge of the joint can grow outward, forming bony spurs. The ligaments slowly thicken and shrink, as if they were trying to push the joint back into shape. The muscles that move the joint gradually weaken and can become thin or wasted.
Osteoarthritis pain is usually felt in the inside part of the knee. As the cartilage is worn away on one side of the joint, patients might find themselves becoming more knock-kneed or bowlegged.
The wedges are designed to help realign the foot and knee, and redistribute the loads on the knee to give the patient pain relief. They can also work as shock absorbers.
In effect, the wedges alter the angles between the foot and knee. The shape of the wedge and its position in the shoe is determined individually for each patient based on X-rays and other data.
Around 550,000 people in the U.K. suffer from arthritis of the knee. Their current treatments provide relief, but not a cure. In fact, these treatments include medication that can help ease the inflammation, but might also be contributing to the pain. Physical therapy can strengthen the muscles around the knee and might also help it soak up some of the shock imparted to the joint.
"We believe that the wedged orthosis will result in altered gait mechanics that reflect a reduction in knee joint pain and increased functioning," say the researchers at the University of Delaware, where one of the clinical trials in under way.
The researchers, whose trial involves 120 patients between 40 and 70, will examine how well the bones line up after the device has been used for two years. The team will also look at the effects on pain.
A second study at Boston University is looking at how well realignment therapy, using a knee brace as well as shoe wedges, works for the same type of patients.
The third study will look at the effectiveness of orthotic shoe inserts in controlling and relieving knee arthritis, and at how it changes the loading on the knee.
Earlier, smaller studies have shown that the wedges can be effective, not only in providing pain relief, but also in supporting muscles and improving functioning. One study showed that participants experienced decreased pain and stiffness after six months.
Another study, at Fukui University Hospital in Japan, shows that wedges do change the pressures on the knee when walking: "The results support the recommendation of using lateral wedged insoles for patients with early and mild knee osteoarthritis," say the researchers.
Source: Daily Mail; London (UK). Provided by ProQuest Information and Learning. Powered by Yellowbrix.
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