In the united states, osteoarthritis is the No. 1 cause of disability. The “graying” of America, in concert with an ever-growing prevalence of obesity, portends an equally expanding population of osteoarthritis.
Osteoarthritis of the knee (OA-K) can be particularly disabling, and currently available medical treatments, such as NSAIDs, topical analgesics, and opioids, each have limitations. Hence, short of surgical intervention, alternatives — such as non-pharmacologic treatment — are sought.
Medial OA-K is one of the most common subtypes. In theory, load reduction on the medical compartment might alleviate symptoms, disease progression, or both. By placing an angulated wedge under the sole of the foot, such load reduction can be achieved. A meta-analysis was performed (n = 885) by Parkes et al to evaluate the efficacy of mechanical interventions intended to unload the medial knee compartment including wedges or structured shoes.
Overall, studies did confirm a positive effect of devices to unload the medial compartment, although the effect size was not large. Additionally, trials with an active control (such as a neutral vs an offloading wedge) failed to confirm positive effects. These mixed results call into question whether clinicians can be confident in the efficacy of wedge insoles.
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