Lateral wedge insoles and foot orthoses for medial knee osteoarthritis: a systematic review of pain and the knee adduction moment

INTRODUCTION

Osteoarthritis of the knee is among the most disabling musculoskeletal conditions worldwide, and its burden rises steadily as the population ages and as obesity becomes more prevalent. Estimates from the Global Burden of Disease have placed hip and knee osteoarthritis among the leading contributors to years lived with disability, and the knee accounts for the greater share of that burden.(1) The medial tibiofemoral compartment bears most of the load transmitted through the joint during walking, which explains why isolated medial disease is the most common radiographic pattern in clinical practice. The external knee adduction moment, the product of the frontal plane ground reaction force and its lever arm relative to the knee joint centre, has long served as the principal biomechanical surrogate of medial compartment loading, because a higher moment reflects a more medial position of the resultant force.(2) The relationship between this moment and the patient experience of pain is, however, modest and inconsistent, a point that has been quantified in recent syntheses of the biomechanical literature.(3)

Lateral wedge insoles and foot orthoses are inexpensive, non invasive devices that were designed to unload the medial compartment through the foot. A lateral wedge tilts the foot into eversion, moves the centre of pressure toward the lateral side of the shoe and shortens the frontal plane lever arm of the ground reaction force, all of which lower the external knee adduction moment measured in the gait laboratory.(4) Foot orthoses prescribed for medial knee osteoarthritis usually combine a lateral wedge with a medial arch support, a subtalar strap or, more recently, custom geometry produced by three dimensional printing, and each of these design choices is expected to modify both the magnitude and the inter individual reproducibility of the unloading effect.(5,6) The theoretical appeal of the approach is strong: because the wedge acts upstream of the knee through the foot, it does not require muscle strength or adherence to an exercise programme, and it can be worn throughout the day inside ordinary footwear. The trade off is that the same wedge that unloads the medial compartment also everts the ankle and rearfoot, which may displace load toward the lateral ankle structures or toward the patellofemoral joint, and this is one of the mechanisms proposed to explain why some patients do not tolerate or do not benefit from the device.(7)

The published evidence is discordant, and this is precisely why the intervention remains controversial. Meta analyses of randomised trials concluded that lateral wedge insoles do not produce a clinically meaningful reduction in knee pain, even though they consistently reduce the adduction moment in laboratory studies.(4,5) Earlier systematic reviews reached similarly cautious conclusions about the efficacy of laterally wedged insoles,(8) and a systematic review restricted to placebo controlled comparisons reached the same conclusion.(9) The Cochrane review of braces and orthoses judged the evidence to be of low certainty.(10) Large randomised trials found no symptomatic advantage of a lateral wedge over a neutral insole at twelve months,(11) and early crossover studies from the preceding decade had already suggested that the pain benefit was at best modest.(12,13) A more recent trial that first excluded biomechanical non responders before randomisation reported a small but statistically significant pain benefit,(14) which re opened the debate about whether the devices fail on average because they are offered to the wrong patients. Since 2015 the literature has therefore shifted from the question of whether lateral wedge insoles work on average toward two narrower questions, namely which patients respond and which insole design achieves the most reliable unloading, and this recent evidence has not been brought together in a synthesis confined to the past decade. The same period saw the spread of responder analysis, three dimensional printed orthoses and wearable sensors for gait monitoring, developments that make a dedicated synthesis of the 2015 to 2024 evidence timely even though several earlier reviews exist.

The objective of this systematic review was to synthesise the evidence published between 2015 and 2024 on the effects of lateral wedge insoles and foot orthoses in adults with medial knee osteoarthritis. The review had three specific objectives: to describe the design, population and methodological quality of the included studies; to determine whether these devices reduce self reported knee pain and physical function; and to determine whether they reduce the knee adduction moment and related surrogates of medial knee load.

METHODS

This systematic review was conducted and reported according to the PRISMA 2020 statement.(15)

Studies were eligible when they enrolled adults with medial tibiofemoral knee osteoarthritis; evaluated a lateral wedge insole or a foot orthosis intended to unload the medial compartment; compared the device with a neutral or flat insole, a sham device, no device, usual care or another orthosis; and reported at least one of knee pain, self reported physical function or the knee adduction moment or a related measure of medial load.

Randomised trials, crossover trials, quasi experimental studies and prospective cohorts were included. Reviews, protocols, editorials, case reports, computational studies without human participants and studies that enrolled only healthy participants were excluded. Publications had to fall between 2015 and 2024 and to provide an English or Spanish title and abstract. Studies were not excluded on the basis of the wedge angle, the type of foot orthosis or the choice of comparator, so that the full range of designs used in clinical practice was captured.

Scopus, PubMed, OpenAlex and Crossref were searched. The core search combined population and intervention terms with a publication year filter, for example in Scopus: TITLE-ABS-KEY("lateral wedge" AND "knee osteoarthritis") AND PUBYEAR > 2014 AND PUBYEAR < 2025. Equivalent queries used "foot orthoses", "laterally wedged", "knee adduction moment" and "valgus insole" as variants, and the same strategy was adapted to the syntax of each database. In full, the five core queries were TITLE-ABS-KEY("lateral wedge" AND "knee osteoarthritis"), TITLE-ABS-KEY("laterally wedged" AND knee), TITLE-ABS-KEY("foot orthoses" AND "knee osteoarthritis"), TITLE-ABS-KEY("knee adduction moment" AND (insole OR orthoses OR wedge)) and TITLE-ABS-KEY("valgus insole" AND knee), each combined with the publication year filter. Supplementary searches for contextual and methodological literature used the terms "medial knee osteoarthritis", "knee adduction moment", "meta-analysis" and "biomechanics" without a lower date limit.

One reviewer extracted, for each included study, the design, country, sample size, population, intervention, comparator, outcomes and the main result with its estimate, using the full text when it was openly accessible and the abstract otherwise. Data were recorded in a structured table and were not re extracted independently, so extraction errors cannot be excluded.

The extraction form recorded first author and year, country, design, sample characteristics, the insole or orthosis specification including wedge angle, arch support, subtalar strap and manufacturing method, the comparator, the outcome measures and their time points, and the main quantitative result. Percentage changes in the adduction moment and in pain scores were transcribed as reported by the authors and were not recalculated. When a study reported several outcome domains, the pain, function and knee adduction moment results were prioritised for the narrative synthesis.

Randomised trials were assessed with the revised Cochrane risk of bias tool, RoB 2.(16) Crossover and quasi experimental biomechanical studies, cohorts and cross sectional analyses were assessed with a domain based checklist derived from the JBI appraisal instruments, covering selection, confounding, measurement and completeness of outcome reporting. Each study received an overall judgement of low, some concerns or high risk of bias. No study was excluded solely for risk of bias.

RESULTS

Characteristics of the included studies

The 55 included studies were published between 2015 and 2024, with the largest number appearing in 2022 (Figure 1). The designs comprised twelve parallel group randomised trials, six randomised crossover trials, sixteen repeated measures biomechanical laboratory experiments, eleven quasi experimental or single arm studies, four prospective cohorts and six case control or cross sectional analyses. Sample sizes ranged from 8 to 90 participants, and most studies enrolled fewer than 40.

The settings reported in the largest numbers were Iran (8 studies), Japan (7), Pakistan (4), Germany (3) and the United Kingdom (3), with additional studies from Brazil, Canada, India, Italy and Taiwan (2 each) and single studies from the United States, Egypt, Bangladesh and Hong Kong; sixteen studies did not state the country. Outcome instruments varied widely. Pain was measured with a visual analogue scale, the WOMAC pain subscale or the KOOS pain subscale in the majority of the clinical studies, whereas the biomechanical studies reported the first and second peaks and the impulse of the external knee adduction moment, normalised to body weight and height in most cases. Medial meniscus extrusion was quantified by ultrasound in a subset of Japanese studies, and balance was quantified with centre of pressure variables, the Timed Up and Go test or static posturography. Lateral wedge insoles varied in inclination from 2 to 11 degrees and were combined in different studies with a medial arch support, a subtalar strap or a valgus knee brace, whereas the foot orthoses ranged from prefabricated wedges to custom and three dimensional printed devices (Table 1). The comparator conditions were correspondingly diverse, including neutral or flat insoles, barefoot or shoe only walking, valgus knee braces, ankle foot orthoses, conventional physiotherapy and no treatment, which complicates direct comparison across studies.

DISCUSSION

The expectation that a demonstrable reduction in the knee adduction moment would translate into a proportionate reduction in knee pain was only partly confirmed. Lateral wedge insoles and foot orthoses unload the medial compartment of the knee reliably and in a dose dependent manner in the laboratory, but the magnitude of unloading is small, it is not reproduced in every participant and it does not translate into a consistent symptomatic benefit. This contrast between a robust biomechanical signal and a weak clinical signal is the central finding of the review, and it is the same contrast that the field has been trying to reconcile since the first randomised trials of wedged insoles were published.(12,13)

The biomechanical results agree with earlier meta analyses, which estimated small immediate reductions in the first peak of the adduction moment of roughly 5 to 8 percent with lateral wedge insoles,(5,71) and with studies showing that arch supported and higher angle wedges augment the effect.(7,72) The absence of a consistent relationship between static foot posture and the biomechanical response, observed in the included studies, agrees with the broader literature on footwear and insoles, which has repeatedly failed to find simple anthropometric predictors of unloading.(51) The present review adds the observation, derived from studies published after 2015, that the dose response extends to custom and three dimensional printed orthoses,(41,43) and that a sizable minority of patients are biomechanical non responders in whom the moment increases rather than decreases.(45,46) This heterogeneity is not random. Responders tend to walk faster, to be female, to have less varus and less severe disease, and to have limited frontal plane ankle mobility, whereas participants with greater hindfoot flexibility unload the knee more with an ankle foot orthosis than with an insole.(48,49) The same individualisation was anticipated by early work that titrated the wedge angle to the patient(73) and by comparisons showing that braces and insoles do not unload the knee equally.(74) These modifiers explain part of the discrepancy between laboratory efficacy and the null results of clinical trials. A further source of inconsistency lies in the comparison condition and the duration of follow up. Studies that used a neutral insole sham found smaller effects than those that compared the wedge with no treatment, and immediate laboratory measurements, which are insensitive to habituation and to clinical relevance, overstate the benefit relative to measurements taken after weeks of wear. The outcome instrument matters as well. The adduction moment responds to a wedge within minutes, whereas pain and function integrate loading, inflammation, central sensitisation and expectation over time, so a concordance between the two is not guaranteed and was in fact rarely observed in the included studies.(3) The finding that the unloading effect can disappear after six weeks while symptoms remain stable illustrates how the early biomechanical response cannot be read as a proxy for clinical outcome.(47)

The pain findings align with the conclusion of the Cochrane review and of the largest meta analysis that a lateral wedge insole does not confer a clinically meaningful average pain benefit over a neutral insole,(4,10) and with a systematic review restricted to placebo controlled comparisons.(9) They also extend the negative result of the twelve month Bennell trial, in which a lateral wedge was no better than a control insole, to the smaller trials published over the past decade.(11,17,18) The one prescreened trial that reported a statistically significant advantage found a between group difference of only 0.7 points on a 0 to 10 scale, an effect that its authors considered clinically relevant in only a minority of patients.(14) Across the placebo controlled comparisons, the point estimates for pain clustered around zero to one point on the numerical scales, and none of the differences reached the commonly proposed minimal clinically important difference for knee osteoarthritis. Studies that lacked a neutral insole control reported larger and more optimistic improvements,(20,26) which illustrates how the absence of a sham comparator inflates the apparent benefit of a device whose main effect may be contextual. Whereas the neutral insole arms of the randomised trials also improved, the uncontrolled studies could not separate the wedge from attention, expectation and the passage of time. The narrative reviews and year in review summaries of the period reached broadly the same reading of this literature.(6,75,76) Taken together, the certainty of the evidence for an average pain benefit is low, because the randomised comparisons are few, mostly unblinded and imprecise, whereas the certainty of the biomechanical evidence is moderate, because the direction of the adduction moment reduction is reproducible across independent laboratories even though its magnitude is modest. This asymmetry in certainty between the biomechanical and the clinical questions is itself informative: it indicates that the failure of the device is not primarily a failure to unload the knee, but a failure of unloading, at the magnitude that is achieved, to translate into symptom relief. A similar reading emerges from the studies that tested the insole and a valgus knee brace head to head, in which the brace generally unloaded the knee and relieved pain more than the insole,(32,74,77) which suggests that the marginal clinical value of the insole is real but small relative to other unloader devices.

For future trials, three design features would materially improve the evidence. First, the comparator should always be a neutral insole of identical appearance, because uncontrolled and brace comparison designs overstate the benefit. Second, the outcome set should pair a patient reported pain measure with the adduction moment measured before and after a habituation period, so that the biomechanical and clinical responses can be examined together in the same participants. Third, the analysis should be stratified by the baseline variables that predict response, particularly varus alignment, hindfoot mobility and gait speed, rather than reporting only the group mean. Trials designed in this way would answer the question that the current literature only begins to address, which is not whether the average patient benefits but which patient benefits.

For clinical practice, the findings support a cautious and selective use of lateral wedge insoles. The devices are inexpensive and safe, and they can be offered to patients who understand that the expected pain relief is small, that benefit is more likely in early disease and in less varus knees, and that a proportion of patients will not unload the knee at all. The prescription should favour a full length wedge of at least 5 degrees, with an arch support when comfort requires it, and should avoid arch support alone, which can increase loading in some patients.(54) Unilateral use should be preferred when the contralateral knee is less symptomatic, given the adverse impact loading observed with bilateral eleven degree wedges.(56) The dose response to wedge angle also suggests that the angle should be titrated to the individual rather than applied as a fixed prescription, a principle that was proposed in early studies of subject specific wedging(73) and that the more recent predictive work on responders now makes actionable.(48) For research, the priority is to replicate the prescreening approach, in which a gait based confirmation of unloading precedes randomisation, and to test whether predicted responders achieve clinically meaningful pain relief in adequately powered trials.(14,45) The same logic applies to the newer custom and three dimensional printed designs, which promise personalisation but have not yet been shown to outperform standard wedges on symptoms.(41,43) Because the expected benefit is modest and the devices are low cost and low risk, shared decision making is appropriate, with the patient informed that the wedge is a trial of therapy whose value should be judged against individual symptoms after a few weeks rather than assumed in advance.

CONCLUSIONS

The available evidence indicates that lateral wedge insoles and foot orthoses reduce the knee adduction moment and medial knee load immediately and in a dose dependent manner in adults with medial knee osteoarthritis, although the effect is small, variable and not maintained in every participant. These devices provide only a small and inconsistent reduction in knee pain and no consistent advantage in physical function over neutral insoles, and the symptomatic benefit appears confined to identifiable subgroups. Unloading of the medial meniscus and improvements in postural control are reported mainly in early disease, which supports the selective, personalised use of these orthoses rather than their routine prescription.

References

1. 1 Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases. 2014;73(7):1323-1330. doi: 10.1136/annrheumdis-2013-204763
2. 2 Wang S, Mo S, Chung RCK, Shull PB, Ribeiro DC, Cheung RTH. How Foot Progression Angle Affects Knee Adduction Moment and Angular Impulse in Patients With and Without Medial Knee Osteoarthritis: A Meta‐Analysis. Arthritis Care &amp;amp; Research. 2021;73(12):1763-1776. doi: 10.1002/acr.24420
3. 3 Hutchison L, Grayson J, Hiller C, D'Souza N, Kobayashi S, Simic M. Relationship Between Knee Biomechanics and Pain in People With Knee Osteoarthritis: A Systematic Review and Meta‐Analysis. Arthritis Care &amp;amp; Research. 2023;75(6):1351-1361. doi: 10.1002/acr.25001
4. 4 Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, et al. Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis. JAMA. 2013;310(7):722. doi: 10.1001/jama.2013.243229
5. 5 Arnold JB, Wong DX, Jones RK, Hill CL, Thewlis D. Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis. Arthritis Care &amp;amp; Research. 2016;68(7):936-951. doi: 10.1002/acr.22797
6. 6 Bennell KL, Buchbinder R, Hinman RS. Physical therapies in the management of osteoarthritis. Current Opinion in Rheumatology. 2015;27(3):304-311. doi: 10.1097/bor.0000000000000160
7. 7 Hatfield GL, Cochrane CK, Takacs J, Krowchuk NM, Chang R, Hinman RS, et al. Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet. Journal Orthopaedic Research. 2016;34(9):1597-1605. doi: 10.1002/jor.23174
8. 8 Penny P, Geere J, Smith TO. A systematic review investigating the efficacy of laterally wedged insoles for medial knee osteoarthritis. Rheumatol Int. 2013;33(10):2529-2538. doi: 10.1007/s00296-013-2760-x
9. 9 Zhang B, Yu X, Liang L, Zhu L, Dong X, Xiong Y, et al. Is the Wedged Insole an Effective Treatment Option When Compared with a Flat (Placebo) Insole: A Systematic Review and Meta‐Analysis. Evidence-Based Complementary and Alternative Medicine. 2018;2018(1):8654107. doi: 10.1155/2018/8654107
10. 10 Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;2015(3):CD004020. doi: 10.1002/14651858.cd004020.pub3
11. 11 Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A, et al. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ. 2011;342(may18 3):d2912-d2912. doi: 10.1136/bmj.d2912
12. 12 Baker K, Goggins J, Xie H, Szumowski K, LaValley M, Hunter DJ, et al. A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis &amp; Rheumatism. 2007;56(4):1198-1203. doi: 10.1002/art.22516
13. 13 Toda Y, Tsukimura N. A six‐month followup of a randomized trial comparing the efficacy of a lateral‐wedge insole with subtalar strapping and an in‐shoe lateral‐wedge insole in patients with varus deformity osteoarthritis of the knee. Arthritis &amp; Rheumatism. 2004;50(10):3129-3136. doi: 10.1002/art.20569
14. 14 Felson DT, Parkes M, Carter S, Liu A, Callaghan MJ, Hodgson R, et al. The Efficacy of a Lateral Wedge Insole for Painful Medial Knee Osteoarthritis After Prescreening: A Randomized Clinical Trial. Arthritis &amp; Rheumatology. 2019;71(6):908-915. doi: 10.1002/art.40808
15. 15 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021:n71. doi: 10.1136/bmj.n71
16. 16 Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019:l4898. doi: 10.1136/bmj.l4898
17. 17 Ferreira V, Machado L, Vilaça A, Xará-Leite F, Roriz P. Effects of tailored lateral wedge insoles on medial knee osteoarthritis based on biomechanical analysis: 12-week randomized controlled trial. Clin Rehabil. 2021;35(9):1235-1246. doi: 10.1177/0269215521997988
18. 18 Campos GCD, Rezende MU, Pasqualin T, Frucchi R, Bolliger Neto R. Lateral wedge insole for knee osteoarthritis: randomized clinical trial. Sao Paulo Med J. 2015;133(1):13-19. doi: 10.1590/1516-3180.2013.6750002
19. 19 A. S. Application of Lateral Wedge in Knee Osteoarthritis for Improving Pain and Quality of Life. J Liaquat Uni Med Health Sci. 2019;18(02):146-151. doi: 10.22442/jlumhs.191820618
20. 20 Hsieh RL, Lee WC. Clinical effects of lateral wedge arch support insoles in knee osteoarthritis. Medicine. 2016;95(27):e3952. doi: 10.1097/md.0000000000003952
21. 21 Mohammad Shah S, Ashraf N, Hassan D, Waseem Akhtar M. Effect of Physical Therapy Treatment in Knee Osteoarthritis with and without Wedge Insole: Randomized Controlled Trial. PBMJ. 2022. doi: 10.54393/pbmj.v5i3.144
22. 22 Hamed AMSEA, Zamzam ML, El-Sebaie MA, Ahmed SF. The effects of lateral wedge insoles on primary knee osteoarthritis patients. Egypt Rheumatol Rehabil. 2019;46(3):189-194. doi: 10.4103/err.err_46_18
23. 23 Center of Advanced Studies in Health and Technology, Rawalpindi Pakistan, Riaz R, Althomali OW, College of Applied Medical Sciences University of Hail, Hail, Kingdom of Saudi Arabia, Sultana B, Isra Institute of Rehabilitation Sciences, Isra University, Islamabad Pakistan, et al. EFFECTIVENESS OF LATERAL WEDGE INSOLE ON KNEE OSTEOARTHRITIS OUTCOMES IN PAKISTANI POPULATION. T Rehabili J. 2022;06(02):361-366. doi: 10.52567/trj.v6i02.174
24. 24 Falahatgar M, Jalali M, Babaee T, Safaeepour Z, Torkaman A, Baniasad M. Comparing Two Orthoses for Managing Medial Knee Osteoarthritis: Lateral Wedge with Subtalar Strap While Barefoot Versus Lateral Wedged Insole Fitted Within Sandal. JOIO. 2022;56(2):319-326. doi: 10.1007/s43465-021-00477-4
25. 25 Khan MTI, Ahmed B, Salek A, Karim F. A Comparative Study of the Effects of Lateral Wedge Insole Shoe Modification on the Patients with Knee Osteoarthritis. TAJ: J of Teachers Assoc. 2018;30(2):13-19. doi: 10.3329/taj.v30i2.39132
26. 26 Zangi M. The Effect of Lateral Wedge Insole on Mediolateral Static Balance in Patients with Mild to Moderate Knee Osteoarthritis. Func Disabil J. 2018;1(1):58-67. doi: 10.30699/fdisj.01.1.58
27. 27 Kumar R, K. Sinha A, Kumar R. Effect of Lateral Wedge in Reduction of Knee Pain and Improvement of Gait Parameter in Subject with Knee Osteoarthritis: in Context with Indian Population. Int J Health Sci Res. 2022;12(4):55-63. doi: 10.52403/ijhsr.20220406
28. 28 Faim Z, Khan MK, Shah W, Uzma B. Effectiveness of Lateral Heel Wedge in Patient Suffering from Knee Osteoarthritis. JPOST. 2023;2(2):45-49. doi: 10.36082/jpost.v2i2.1194
29. 29 Esfandiari E, Sanjari MA, Jamshidi AA, Kamyab M, Yazdi HR. Knee osteoarthritis at the early stage: The four-week effect of lateral wedge insole on pain and risk of falls. Med J Islam Republic Iran. 2018;32(1):94-99. doi: 10.14196/mjiri.32.17
30. 30 Barati K, Ebrahimi Takamjani I, Shamsoddini A, Ejraei Dolatabad H. A comparison of the biomechanical and clinical effects of a biaxial ankle-foot orthosis and lateral wedge insole in individuals with medial knee osteoarthritis. Disability and Rehabilitation. 2022;44(26):8501-8508. doi: 10.1080/09638288.2021.2019841
31. 31 Bartsch LP, Schwarze M, Block J, Alimusaj M, Schiltenwolf M, Jaber A, et al. Varus Knee Limits Pain Relief Effects of Laterally Wedged Insoles and Ankle-Foot Orthoses in Medial Knee Osteoarthritis. JRM. 2022;54:jrm00324. doi: 10.2340/jrm.v54.1129
32. 32 Dwarakanathan R, Mohanty RK, Sahoo S, Prasad S. Efficacy of unloader knee orthosis and lateral wedge insole on static balance in medial knee osteoarthritis. Journal of Orthopaedics, Trauma and Rehabilitation. 2022;29(1):22104917221095256. doi: 10.1177/22104917221095256
33. 33 Robert-Lachaine X, Dessery Y, Belzile ÉL, Corbeil P. Knee braces and foot orthoses multimodal treatment of medial knee osteoarthritis. Gait &amp; Posture. 2022;96:251-256. doi: 10.1016/j.gaitpost.2022.06.004
34. 34 Robert‐Lachaine X, Dessery Y, Belzile ÉL, Corbeil P. Knee braces and foot orthoses multimodal 3‐month treatment of medial knee osteoarthritis in a randomised crossover trial. Knee surg sports traumatol arthrosc. 2024;32(11):2919-2930. doi: 10.1002/ksa.12312
35. 35 Khosravi M, Arazpour M, Sharafat Vaziri A. An evaluation of the use of a lateral wedged insole and a valgus knee brace in combination in subjects with medial compartment knee osteoarthritis (OA). Assistive Technology. 2021;33(2):87-94. doi: 10.1080/10400435.2019.1595788
36. 36 Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA. Combined effects of knee brace, laterally wedged insoles and toe-in gait on knee adduction moment and balance in moderate medial knee osteoarthritis patients. Gait &amp; Posture. 2018;61:243-249. doi: 10.1016/j.gaitpost.2018.01.024
37. 37 Hsu WC, Jhong YC, Chen HL, Lin YJ, Chen LF, Hsieh LF. Immediate and long-term efficacy of laterally-wedged insoles on persons with bilateral medial knee osteoarthritis during walking. BioMed Eng OnLine. 2015;14(1):43. doi: 10.1186/s12938-015-0040-6
38. 38 Jones RK, Chapman GJ, Parkes MJ, Forsythe L, Felson DT. The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial. Journal Orthopaedic Research. 2015;33(11):1646-1654. doi: 10.1002/jor.22947
39. 39 Jafarnezhadgero AA, Oliveira AS, Mousavi SH, Madadi-Shad M. Combining valgus knee brace and lateral foot wedges reduces external forces and moments in osteoarthritis patients. Gait &amp; Posture. 2018;59:104-110. doi: 10.1016/j.gaitpost.2017.09.040
40. 40 Schwarze M, Bartsch LP, Block J, Alimusaj M, Jaber A, Schiltenwolf M, et al. A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial. Clin Rehabil. 2021;35(7):1032-1043. doi: 10.1177/0269215521993636
41. 41 Lin KW, Chou LW, Su YT, Wei SH, Chen CS. Biomechanical Effect of 3D-Printed Foot Orthoses in Patients with Knee Osteoarthritis. Applied Sciences. 2021;11(9):4200. doi: 10.3390/app11094200
42. 42 Ferreira V, Machado L, Vilaça A, Xará-Leite F, Roriz P. Can Slight Variations to Lateral Wedge Insoles Induce Significant Biomechanical Changes in Patients with Knee Osteoarthritis?. Biomechanics. 2022;2(3):342-351. doi: 10.3390/biomechanics2030027
43. 43 Allan R, Woodburn J, Telfer S, Abbott M, Steultjens MP. Knee joint kinetics in response to multiple three-dimensional printed, customised foot orthoses for the treatment of medial compartment knee osteoarthritis. Proc Inst Mech Eng H. 2017;231(6):487-498. doi: 10.1177/0954411917691318
44. 44 Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA. Combined effects of knee brace, laterally wedged insoles, and toe-out gait on knee adduction moment and fall risk in moderate medial knee osteoarthritis patients. Prosthet Orthot Int. 2019;43(2):148-157. doi: 10.1177/0309364618796849
45. 45 Chapman GJ, Parkes MJ, Forsythe L, Felson DT, Jones RK. Ankle motion influences the external knee adduction moment and may predict who will respond to lateral wedge insoles?: an ancillary analysis from the SILK trial. Osteoarthritis and Cartilage. 2015;23(8):1316-1322. doi: 10.1016/j.joca.2015.02.164
46. 46 Mannisi M, Dell’Isola A, Andersen MS, Woodburn J. Effect of lateral wedged insoles on the knee internal contact forces in medial knee osteoarthritis. Gait &amp; Posture. 2019;68:443-448. doi: 10.1016/j.gaitpost.2018.12.030
47. 47 Duivenvoorden T, van Raaij TM, Horemans HLD, Brouwer RW, Bos KP, Bierma-Zeinstra SMA, et al. Do Laterally Wedged Insoles or Valgus Braces Unload the Medial Compartment of the Knee in Patients With Osteoarthritis?. Clin Orthop Relat Res. 2015;473(1):265-274. doi: 10.1007/s11999-014-3947-5
48. 48 Hunt MA, Tse CTF, Ryan MB, Scott A, Sayre EC. Clinically‐accessible and laboratory‐derived predictors of biomechanical response to standalone and supported lateral wedge insoles in people with knee osteoarthritis. Journal of Foot and Ankle Research. 2023;16(1):74. doi: 10.1186/s13047-023-00671-7
49. 49 Bartsch LP, Schwarze M, Block J, Alimusaj M, Hadzic A, Renkawitz T, et al. Hindfoot Flexibility Influences the Biomechanical Effects of Laterally Wedged Insoles and Ankle-Foot Orthoses in Medial Knee Osteoarthritis. Archives of Physical Medicine and Rehabilitation. 2022;103(9):1699-1706. doi: 10.1016/j.apmr.2022.02.012
50. 50 Edo M, Nishizawa G, Matsumura Y, Nemoto N, Yotsumoto N, Kojima S. The Relationship Between the Effects of Lateral Wedge Insoles and Kinematic Chain Dynamics Between the Hindfoot and Lower Leg in Patients With Osteoarthritis of the Knee. Cureus. 2023;15(4):e37624. doi: 10.7759/cureus.37624
51. 51 Lewinson RT, Madden R, Killick A, Wannop JW, Preston Wiley J, Lun VMY, et al. Foot structure and knee joint kinetics during walking with and without wedged footwear insoles. Journal of Biomechanics. 2018;73:192-200. doi: 10.1016/j.jbiomech.2018.04.006
52. 52 Ishii Y, Ishikawa M, Kurumadani H, Sunagawa T, Date S, Takahashi M, et al. The Effect of Lateral Wedge Insole on Gait Variability Assessed Using Wearable Sensors in Patients with Medial Compartment Knee Osteoarthritis. Journal of Healthcare Engineering. 2023;2023(1):6172812. doi: 10.1155/2023/6172812
53. 53 Tse CTF, Ryan MB, Krowchuk NM, Scott A, Hunt MA. Osteoarthritic Tibiofemoral Joint Contact Characteristics During Weightbearing With Arch-Supported and Standalone Lateral Wedge Insoles. J Appl Biomech. 2024;40(4):270-277. doi: 10.1123/jab.2023-0168
54. 54 Dessery Y, Belzile É, Turmel S, Corbeil P. Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis. Prosthet Orthot Int. 2017;41(4):356-363. doi: 10.1177/0309364616661254
55. 55 Dessery Y, Belzile ÉL, Turmel S, Corbeil P. Use of Two-Piece Foot Orthoses to Adjust Lateral Inclination Angle in Medial Knee Osteoarthritis Treatment. J Prosthet Orthot. 2016;28(3):114-117. doi: 10.1097/jpo.0000000000000098
56. 56 Abd El Megeid Abdallah AA. Effect of unilateral and bilateral use of laterally wedged insoles with arch supports on impact loading in medial knee osteoarthritis. Prosthet Orthot Int. 2016;40(2):231-239. doi: 10.1177/0309364614560942
57. 57 Esfandiari E, Kamyab M, Yazdi HR, Sanjari MA, Navvab Motlagh F. The effect of a lateral wedge insole and a subtalar strap on gait parameters in knee osteoarthritis. Med J Islam Republ Iran. 2019;33(1):157. doi: 10.47176/mjiri.33.157
58. 58 Ishii Y, Ishikawa M, Nakashima Y, Takahashi M, Iwamoto Y, Okada K, et al. Dynamic response of medial meniscus extrusion to the lateral wedge insole is correlated with immediate pain reduction in knee osteoarthritis patients: real-time ultrasonographic study. J Med Ultrasonics. 2022;49(4):731-738. doi: 10.1007/s10396-022-01234-2
59. 59 Ishii Y, Deie M, Fujita N, Kurumadani H, Ishikawa M, Nakamae A, et al. Effects of lateral wedge insole application on medial compartment knee osteoarthritis severity evaluated by ultrasound. The Knee. 2017;24(6):1408-1413. doi: 10.1016/j.knee.2017.09.001
60. 60 Ishii Y, Ishikawa M, Hayashi S, Kanemitsu M, Omoto T, Kurumadani H, et al. The correlation between osteoarthritis stage and the effect of the lateral wedge insole for 3 months on medial meniscus extrusion in the knee joint. The Knee. 2021;28:110-116. doi: 10.1016/j.knee.2020.11.016
61. 61 Ishii Y, Ishikawa M, Shimada N, Takahashi M, Iwamoto Y, Date S, et al. Effect of lateral wedge insole on medial meniscus extrusion and its association with knee osteoarthritis progression. Prosthet Orthot Int. 2024;48(5):533-539. doi: 10.1097/pxr.0000000000000320
62. 62 Akbari M, Saeedi H, Babaee T. The Effect of Lateral Wedge and Medial Arch Support on Displacement of Ground Reaction Force in Patients with Knee Osteoarthritis. J Rehabil. 2016;17(1):72-81. doi: 10.20286/jrehab-170172
63. 63 Esfandiari E, Sanjari MA, Jamshidi AA, Kamyab M, Yazdi HR. Gait initiation and lateral wedge insole for individuals with early knee osteoarthritis. Clinical Biomechanics. 2020;80:105163. doi: 10.1016/j.clinbiomech.2020.105163
64. 64 Katoh H. Effect of lateral-wedge insole on the center of foot pressure and lower extremity muscle activity at gait initiation in patients with medial knee osteoarthritis. J Phys Ther Sci. 2019;31(10):776-779. doi: 10.1589/jpts.31.776
65. 65 Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong, Fu HC, Lie CW, Ng T, Chen K, Tse C, et al. Prospective study on the effects of orthotic treatment for medial knee osteoarthritis in Chinese patients: clinical outcome and gait analysis. Hong Kong Med J. 2015;21(2):98-106. doi: 10.12809/hkmj144311
66. 66 Mirzaei F, Arazpour M, Baghei Roodsari R, Bahramizadeh M, Mardani MA. Combined Effects of a Valgus Knee Brace and Lateral Wedge Insole on Walking in Patients with Medial Compartment Knee Osteoarthritis. J Prosthet Orthot. 2018;30(1):39-45. doi: 10.1097/jpo.0000000000000170
67. 67 Pandey J, Gupta AK, Kumar D, Agarwal A, Mishra S, Yadav G. Immediate Effect of Valgus Knee Brace and Lateral Wedge Insole on Gait Parameters in Medial Compartment Osteoarthritis of Knee: A Cross-sectional Study. JCDR. 2021. doi: 10.7860/jcdr/2021/48510.15503
68. 68 Okamoto S, Ishii Y, Ishikawa M, Nakashima Y, Kamei G, Iwamoto Y, et al. The effect of gait modification on the response of medial meniscus extrusion during gait in patients with knee osteoarthritis. Gait &amp; Posture. 2023;102:180-185. doi: 10.1016/j.gaitpost.2023.03.017
69. 69 Jaques G, Ulrich B, Hoffmann L, Jolles BM, Favre J. Walking with Different Insoles Changes Lower-Limb Biomechanics Globally in Patients with Medial Knee Osteoarthritis. JCM. 2023;12(5):2016. doi: 10.3390/jcm12052016
70. 70 Hsu WC, Chou LW, Chiu HY, Hsieh CW, Hu WP. A Study on the Effects of Lateral-Wedge Insoles on Plantar-Pressure Pattern for Medial Knee Osteoarthritis Using the Wearable Sensing Insole. Sensors. 2022;23(1):84. doi: 10.3390/s23010084
71. 71 Shaw KE, Charlton JM, Perry CKL, de Vries CM, Redekopp MJ, White JA, et al. The effects of shoe-worn insoles on gait biomechanics in people with knee osteoarthritis: a systematic review and meta-analysis. Br J Sports Med. 2018;52(4):238-253. doi: 10.1136/bjsports-2016-097108
72. 72 Xing F, Lu B, Kuang MJ, Wang Y, Zhao YL, Zhao J, et al. A systematic review and meta-analysis into the effect of lateral wedge arch support insoles for reducing knee joint load in patients with medial knee osteoarthritis. Medicine (Baltimore). 2017;96(24):e7168. doi: 10.1097/md.0000000000007168
73. 73 Butler RJ, Marchesi S, Royer T, Davis IS. The effect of a subject‐specific amount of lateral wedge on knee mechanics in patients with medial knee osteoarthritis. Journal Orthopaedic Research. 2007;25(9):1121-1127. doi: 10.1002/jor.20423
74. 74 Jones RK, Nester CJ, Richards JD, Kim WY, Johnson DS, Jari S, et al. A comparison of the biomechanical effects of valgus knee braces and lateral wedged insoles in patients with knee osteoarthritis. Gait &amp; Posture. 2013;37(3):368-372. doi: 10.1016/j.gaitpost.2012.08.002
75. 75 Beaudreuil J. Orthoses for osteoarthritis: A narrative review. Annals of Physical and Rehabilitation Medicine. 2017;60(2):102-106. doi: 10.1016/j.rehab.2016.10.005
76. 76 Diamond LE, Grant T, Uhlrich SD. Osteoarthritis year in review 2023: Biomechanics. Osteoarthritis and Cartilage. 2024;32(2):138-147. doi: 10.1016/j.joca.2023.11.015
77. 77 Hinman RS, Bowles KA, Payne C, Bennell KL. Effect of length on laterally‐wedged insoles in knee osteoarthritis. Arthritis &amp; Rheumatism. 2008;59(1):144-147. doi: 10.1002/art.23249