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NEWS ITEMS - Isabel Baert OA

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The effect of lateral wedge insoles in
patients with knee osteoarthritis:
Balancing biomechanics with pain
neuroscience

Results on the effects of lateral wedge insoles (LWIs) in patients with medial knee osteoarthritis (OA) are ambiguous and not fully understood. However, because of the low cost of this intervention and its clinical utility, attention to the use of LWIs is worth considering.

Current insights on the efficacy of LWIs are mainly focused on changing biomechanical aspects, such as the external knee adduction moment, in an attempt to influence pain, functional ability and structural progression. It is however appropriate to interpret the effectiveness of LWIs in a broader concept than the pure biomechanical approach. Given our current understanding of OA-related pain, including the involvement of the central nervous system and nociception-motor interactions, concepts of pain neuroscience should be taken into account.

In a recently published review, Pain in Motion researchers summarize the current state of knowledge regarding the biomechanical effect of LWIs in patients with knee OA. They discuss the degree to which such biomechanical effect translates to clinical effects (symptom relief, function recovery and reduction of structural progression). In order to explain these clinical effects, this paper balances biomechanics with pain neuroscience.

Despite beneficial biomechanical effects (reduction in knee adduction moment and knee joint loading) of LWIs, there is insufficient evidence for clinically important effects or significant reductions in disease progression. Evaluating the effects of LWIs, our current understanding of OA-related pain should be taken into account, as LWIs may be part of a comprehensive biopsychosocial treatment. Future work on all of the variables that could influence clinical outcomes in order to decide in which subgroups of patients LWIs are (most) effective is necessary.

Isabel Baert

2014 Pain in Motion

References and further reading:

Baert I, Nijs J, Meeus M, Lluch E, Struyf F. The effect of lateral wedge insoles in patients with medial compartment knee osteoarthritis: balancing biomechanics with pain neuroscience. Clinical Rheumatology, May 2014, DOI 10.1007/s10067-014-2668-1
http://www.ncbi.nlm.nih.gov/pubmed/24844545