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Combined Effects of a Valgus Knee Brace and Lateral Wedge Foot Orthotic on the External Knee Adduction Moment in Patients With Varus Gonarthrosis

  • Rebecca F. Moyer
    Affiliations
    Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada

    School of Physical Therapy, Faculty of Healthy Sciences, University of Western Ontario, London, Ontario, Canada
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  • Trevor B. Birmingham
    Correspondence
    Corresponding author Trevor B. Birmingham, PhD, PT, School of Physical Therapy, Elborn College, University of Western Ontario, London, Ontario, Canada N6G 1H1.
    Affiliations
    Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada

    School of Physical Therapy, Faculty of Healthy Sciences, University of Western Ontario, London, Ontario, Canada
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  • Colin E. Dombroski
    Affiliations
    Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
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  • Robert F. Walsh
    Affiliations
    Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
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  • Kristyn M. Leitch
    Affiliations
    Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada

    Department of Biomedical Engineering, University of Western Ontario, London, Ontario, Canada
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  • Thomas R. Jenkyn
    Affiliations
    Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada

    Department of Mechanical and Materials Engineering, University of Western Ontario, London, Ontario, Canada
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  • J. Robert Giffin
    Affiliations
    Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada

    Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
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Published:September 19, 2012DOI:https://doi.org/10.1016/j.apmr.2012.09.004

      Abstract

      Objective

      To test the hypothesis that a custom-fit valgus knee brace and custom-made lateral wedge foot orthotic will have greatest effects on decreasing the external knee adduction moment during gait when used concurrently.

      Design

      Proof-of-concept, single test session, crossover trial.

      Setting

      Biomechanics laboratory within a tertiary care center.

      Participants

      Patients (n=16) with varus alignment and knee osteoarthritis (OA) primarily affecting the medial compartment of the tibiofemoral joint (varus gonarthrosis).

      Interventions

      Custom-fit valgus knee brace and custom-made full-length lateral wedge foot orthotic. Amounts of valgus angulation and wedge height were tailored to each patient to ensure comfort.

      Main Outcome Measures

      The external knee adduction moment (% body weight [BW]*height [Ht]), frontal plane lever arm (cm), and ground reaction force (N/kg), determined from 3-dimensional gait analysis completed under 4 randomized conditions: (1) control (no knee brace, no foot orthotic), (2) knee brace, (3) foot orthotic, and (4) knee brace and foot orthotic.

      Results

      The reduction in knee adduction moment was greatest when concurrently using the knee brace and foot orthotic (effect sizes ranged from 0.3 to 0.4). The mean decrease in first peak knee adduction moment compared with control was .36% BW*Ht (95% confidence interval [CI], –.66 to –.07). This was accompanied by a mean decrease in frontal plane lever arm of .59cm (95% CI, –.94 to –.25).

      Conclusions

      These findings suggest that using a custom-fit knee brace and custom-made foot orthotic concurrently can produce a greater overall reduction in the knee adduction moment, through combined effects in decreasing the frontal plane lever arm.

      Keywords

      List of abbreviations:

      BW (body weight), CI (confidence interval), Ht (height), OA (osteoarthritis)
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