Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis

OBJECTIVE: Gait biomechanics (knee adduction moment, center of pressure) and static alignment were investigated to determine the mechanical effect of foot orthoses in people with medial compartment knee osteoarthritis. DESIGN: Repeated measures design in which subjects were exposed to three conditions (normal footwear, heel wedge and orthosis) in random order. BACKGROUND: The knee adduction moment is an indirect measure of medial compartment loading. It was hypothesized that the use of a 5 degrees valgus wedge and 5 degrees valgus modified orthosis would shift the center of pressure laterally during walking, thereby decreasing the adduction moment arm and the adduction moment. METHODS: Peak knee adduction moment and center of pressure excursion were obtained in nine subjects with medial compartment knee OA during level walking using an optoelectric system and force plate. Static radiographs were taken in 12 subjects using precision radiographs. RESULTS: There was no difference between conditions in static alignment, the peak adduction moment or excursion of the center of pressure in the medial-lateral direction. No relationship was found between the adduction moment and center of pressure excursion in the medial-lateral plane. The displacement of the center of pressure in the anterior-posterior direction, measured relative to the laboratory coordinate system, was decreased with the orthosis compared to the control condition (P=0.036) and this measure was correlated with the adduction moment (r=0.45, P=0.019). CONCLUSIONS: The proposed mechanism was not supported by the findings. The reduction in the center of pressure excursion in the anterior-posterior direction suggests that foot positioning was altered, possibly to a toe-out position, while subjects wore the orthoses. Based on the current findings, we hypothesize that toe-out positioning may reduce medial joint load. RELEVANCE: Knee Osteoarthritis is the most common cause of chronic disability amongst seniors. Developing inexpensive, non-invasive treatment strategies for this large population has potential to impact health care costs, quality of life and clinical outcomes.