Abstract
Objective
To investigate the relationship of frontal plane ankle mobility with the effects of
an ankle-foot orthosis (AFO) and a laterally wedged insole (LWI) on knee adduction
moment (KAM) in the treatment of medial knee osteoarthritis.
Design
Randomized, nonblinded crossover trial.
Setting
Outpatient clinic of university hospital.
Participants
Referred sample of 20 patients (N=20) with medial knee osteoarthritis stage 1-3 (Kellgren
and Lawrence), aged 56.4±6.5 years; 58 patients were assessed, 21 were included, and
1 was a dropout. There were 14 healthy reference participants without knee osteoarthritis
(convenience sample) who were matched by age.
Interventions
Patients received AFO and LWI for 6 weeks each with gait analysis after each 6-week
intervention. Patients underwent additional barefoot gait analysis, walking on even
ground and on a cross slope of 5° lateral elevation and standing on inclinations of
0°, 5°, 10°, and 20°.
Main Outcome Measures
Spearman correlation between the immediate change in first peak of KAM with each aid
and the change in hindfoot varus on the cross slope relative to level ground.
Results
The KAM reduction with AFO correlated significantly with hindfoot varus reaction to
the cross slope during walking: the greater the hindfoot valgization on the cross
slope, the greater the KAM reduction with AFO (Spearman ρ=0.53, P=.02).
The KAM reduction with LWI correlated moderately negatively with the change in hindfoot
varus: the greater the hindfoot valgization on the cross slope, the smaller the KAM
reduction with LWI (r=−0.31 P=.18).
Conclusions
LWI may be suitable for patients with limited to normal frontal plane ankle mobility.
Patients with greater frontal plane ankle mobility benefit most from frontal plane
ankle bridging with AFO. Studies with larger samples are necessary.
Keywords
List of abbreviations:
AFO (ankle-foot orthosis), KAM (knee adduction moment), LWI (laterally wedged insole)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 11, 2022
Accepted:
February 14,
2022
Received in revised form:
December 15,
2021
Received:
June 1,
2021
Footnotes
Supported by “Deutsche Arthrose-Hilfe e.V.” grant no. P471-A1123.
Clinical Trial Registration No.: DRKS-00016783. The study was registered before enrolling any patients for this analysis.
Disclosures: The ankle-foot orthoses were provided on loan by the company OttoBock Healthcare GmbH. The devices are FDA approved for the indicated usage in the United States. Tobias Renkawitz reports research funding/travel expenses and/or paid speaking engagements by the German Federal Ministry of Education and Research (BMBF), the German Federal Ministry for Economic Cooperation and Development (BMZ), Otto Bock Foundation, Stiftung Oskar-Helene-Heim Berlin, DePuy Int, Zimmer, Aesculap/B. Braun, the Vielberth Foundation, German Society of Ortho-paedics and Traumatology (DGOU), the German Association of Orthopedics and Orthopedic Surgery (DGOOC), and the Professional association for orthopedics and trauma surgery (BVOU). T.R. is associate editor of “Der Orthopäde” and “Der Unfallchirurg” (Springer Heidelberg, Berlin, New York) and member of the International Advisory Board of the Journal of the American Academy of Orthopedic Surgeons (AAOS). The other authors have nothing to disclose.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
