ORIGINAL RESEARCH ARTICLE

Combined Effects of a Valgus Knee Brace and Lateral Wedge

Insole on Walking in Patients with Medial Compartment
Knee Osteoarthritis
Fatemeh Mirzaei, MSc, Mokhtar Arazpour, PhD, Roshanak Baghei Roodsari, PhD, Mahmood Bahramizadeh, PhD, Mohammad Ali Mardani, PhD

ABSTRACT
Introduction: The use of a valgus knee brace and a lateral wedge foot orthosis in patients with knee osteoarthritis (OA) has been
reported as a novel treatment strategy. The purpose of this study was to analyze the combined effect of laterally wedged inlay and
knee brace on walking in volunteer subjects with medial compartment OA.
Materials and Methods: Eighteen subjects with symptomatic medial compartment knee OA participated in this study. Based on
the treatment strategies, all subjects were divided into three groups: (1) lateral wedge insole, (2) valgus knee brace, and (3) both
knee brace and foot orthosis. A Vicon digital motion capture system using eight cameras at a frequency of 100 Hz and two force
platforms were used to capture data.
Results: In the lateral wedge group, a significant difference was observed in the knee adduction moment (KAM) with and with-
out condition. In the valgus brace group, there was a significant difference in KAM, speed of walking, cadence, and knee joint
range of motion (ROM) with and without intervention. In the valgus brace plus lateral wedge insole group, there was a signif-
icant difference in KAM and hip, knee, and ankle joints ROM.
Conclusions: The concurrent use of valgus knee brace and lateral wedge insole can produce a greater overall reduction in the
KAM. The use of two types of orthoses, both separately and combined, did not improve the speed of walking, step length, and
hip, knee, and ankle joints ROM in the affected side. (J Prosthet Orthot. 2018;30:39–45)
KEY INDEXING TERMS: valgus knee brace, lateral wedge insole, walking, medial compartment knee osteoarthritis, kinematics
and kinetics

K
nee osteoarthritis (OA) is a degenerative joint disease
that leads to the degradation of articular cartilage in
the knee joint. Individuals with OA have pain and stiffness
due to change in the structure of the cartilage and narrowing of
the joint space. These mechanical factors play an important role
FATEMEH MIRZAEI MSc and MOKHTAR ARAZPOUR, PhD, are affili-
ated with the Pediatric Neurorehabilitation Research Center, University
of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
MOKHTAR ARAZPOUR, PhD, is affiliated with the Iranian Research
Center on Aging, University of Social Welfare and Rehabilitation Sci-
ences, Tehran, Iran.
FATEMEH MIRZAEI, MSc, MOKHTAR ARAZPOUR, PhD; MAHMOOD
BAHRAMIZADEH, PhD, MOHAMMAD ALI MARDANI, PhD, and
ROSHANAK BAGHAEI ROODSARI, PhD, are affiliated with the Depart-
ment of Orthotics and Prosthetics, University of Social Welfare and
Rehabilitation Sciences, Tehran, Iran.
FATEMEH MIRZAEI, MSc, is affiliated with the Student Research Com-
mute, University of Social Welfare and Rehabilitation Sciences and Knee
and Sport Medicine Research Center, Milad Hospital, Tehran, Iran.
Disclosure: The authors declare no conflict of interest.
Copyright © 2017 American Academy of Orthotists and Prosthetists.
Correspondence to: Mokhtar Arazpour, PhD, Department of Orthotics
and Prosthetics, University of Social Welfare and Rehabilitation Sci-
ence, Kodakyar St., Daneshjo Blvd, Evin, Tehran, 1985713834, Iran;
email: m.arazpour@yahoo.com
in the development and progression of the disease state.1 The
knee joint OA has been shown to develop in approximately 10%
of adults older than 55 years.2 Prevalence of knee OA in the me-
dial compartment is 5 to 10 times higher than disease in the
lateral compartment.3 The suggested reason for this fact is ap-
proximately 60% of load passes through the medial side of the
knee during ambulation.4
Medial compartment OA is more prevalent than lateral com-
partment disease due to the mechanism of load distribution in
normal walking. Approximately 60% of the total load passes
through the medial compartment of the knee in normal sub-
jects, leading to further degenerative changes with medial com-
partment type. This results in the mechanical load passing more
medially through the knee than normal.4,5 Pain, immobility,
disability, a reduced quality of life, and negative changes in ki-
netic and kinematic parameters are the symptoms of medial
compartment OA.6,7
Treatment options for knee OA consist of operative and non-
operative approaches. Operative treatment includes arthroscopy,
joint replacement, and osteotomies. Nonoperative methods are
often prescribed (indicated) in mild to moderates stages or when
surgery is not feasible. These nonoperative treatments consist of
drug therapy, physiotherapy, and orthotics conservative treat-
ments.8 The overall aim of the conservative treatment of OA is to
reduce pain, improve functioning, and reduce disease progression
rates.9 In orthotic conservative treatment, these methods aim to
reduce the externally applied knee adduction moment (KAM)

Volume 30 • Number 1 • 2018 39

Copyright © 2017 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited.
Arazpour et al.
acting on the medial aspect of the knee. The use of laterally
wedged insoles and specifically designed knee braces is a common
conservative method to treat medial compartment knee OA.10
Lateral wedges change the position of the center of pres-
sure by redirecting it more laterally to reduce the KAM.11,12
A study reported that a 5° inclined lateral wedge-type insole
significantly reduced the KAM.13 Other studies demonstrated
the ineffectiveness of a 5° lateral wedge in reducing the external
KAM.14–16 On comparing the different lateral wedges with 3°, 5°,
6°, and 10° inclinations, it was found that a 6° lateral wedge
reflected the minimum correction angle proven to be effective by
previous studies.13,17
Knee braces can be divided into four classes, consisting of
prophylactic, functional, rehabilitative, and valgus off-loader
knee braces. These knee braces are a common nonsurgical strat-
egy for treating people with medial knee OA.18 Knee braces have
also been shown to decrease the net adduction moment applied
by the ground reaction force by applying a constant abduction
(valgus) moment closer to the knee joint center.10 Previous stud-
ies have reported that the wearing of knee braces reduced the load
on the medial compartment for ambulation19 and increased con-
fidence in loading and the ability to push off vertically.20
The use of valgus knee brace and lateral wedge foot ortho-
sis has been reported as a novel treatment strategy for knee
OA. According to a study, the separate evaluation of valgus
knee braces, lateral wedge foot orthoses, and variable stiffness
shoes decreased the external KAM.21 On using a knee brace,
the position of the knee joint center changed in the medial di-
rection. However, the use of a lateral wedge insole altered the
orientation of the ground reaction force in the lateral direc-
tion. Therefore, there might be a possibility of additive effects
on reducing the KAM when these interventions are used to-
gether. Moyer et al.22 evaluated the combined effect of knee
orthosis and lateral wedge insole on 16 medial compartment
knee OA patients and reported that the use of knee brace
and foot orthosis at the same time can produce a greater over-
all reduction in the KAM.
Despite the current evidence, studies evaluating the combined
effect of the knee braces and inlays compared with the effective-
ness of knee orthoses or inlays in treating knee OA are scarce.
Therefore, additional research is required to demonstrate their
effectiveness on the kinetics and kinematics of the lower limb.
Accordingly, the primary objective of this proof-of-concept
study was to test the hypothesis of using two different mecha-
nisms (direct force and indirect force) for correcting the knee
valgus position so as to decrease the external KAM during gait
when used simultaneously. The secondary objective was to ex-
plore the changes in the walking parameters (temporal-spatial,
kinetic, and kinematic) in the medial compartment knee OA.
Therefore, the purpose of this present study was to analyze
and compare the combined effects of the two orthotic treatment
strategies, laterally wedged inlay or a knee brace, on certain pri-
mary outcome measures in volunteer subjects with medial com-
partment OA. The primary outcome measures are knee pain,
KAM, lower-limb sagittal plane kinematics, the speed of walk-
ing, and cadence and step length.
40
Copyright © 2017 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited.
Journal of Prosthetics and Orthotics
METHODS
SUBJECTS
The study included 18 subjects with varus alignment, symp-
tomatic medial compartment knee OA, and those prescribed for
a conservative treatment, who were referred to the Department
of Orthotics and Prosthetics in the University of Social Welfare
and Rehabilitation Sciences. Radiological evaluation combined
with reported knee symptoms associated with radiological eval-
uation were used to diagnose knee OA. The inclusion criteria for
this study included localized pain in the medial side of the
tibiofemoral joint, greater joint space narrowing on the medial
side compared with the lateral side, and the existence of medial
compartment knee OA of Kellgren-Lawrence grade 2 or 3 con-
firmed by radiological examination. Anteroposterior radiographs
of the hip-to-ankle joints in the standing position were used to
evaluate alignment of the knee joint in the frontal plane. A me-
chanical axis angle of ≥1° varus in the knee joint was considered
as varus alignment. Kellgren-Lawrence grades were also detected
according to the full-length standing radiographs. The exclusion
criteria for this study included arthroscopic surgery in the past
6 months; knee trauma and lower-limb amputation; neurological
disease; symptomatic spine, hip, ankle, and foot disease; intra-
articular steroid injection in the past 3 months; hyaluronic acid
injection in the last 9 months; previous fracture of the tibia; skin
disease; peripheral vascular disease; blindness; severe cardiovas-
cular defect; and an inability to apply a brace (due to arthritis in
the hand or difficulty in bending). Signed consent forms were ob-
tained from all the study participants. The ethics committee of
the University of Social Welfare and Rehabilitation Sciences ap-
proved the performance of this study.
TESTING PROTOCOL
The orthotic devices were fitted to the patients' body, and
they were advised to wear the devices for 2 weeks (8 hours per
day) immediately before the time of the initial formal biome-
chanical evaluation. The usage of these devices was properly
checked by researcher via telephone in this study. The 2-week
period was considered sufficient to verify the wearing compli-
ance and permit adequate acclimation to the brace and insole.
The orthotic devices were worn bilaterally in the patients having
bilateral knee pain. Three different groups were considered in
this study: (1) lateral wedge insole (no intervention, with interven-
tion), (2) valgus knee brace (no intervention, with intervention),
and (3) both knee brace and foot orthotic (no intervention, with in-
tervention). Block randomization was used to achieve the same
number of K/L grade 2 versus 3 ratios in each of the 3 groups.
VALGUS KNEE BRACE
All subjects were fitted with a custom-fit valgus knee brace by
an experienced orthotist before the gait analysis was performed.
The knee orthosis was fabricated on a 3-point bending mecha-
nism to provide a medially directed force to the lateral aspect
of the knee joint. The components of the knee brace were in-
cluded in the hard shell cuff around the thigh and shank, with
medially placed hinge and lateral crossover strap. The casting
of the lower limb was performed in the weight-bearing
Volume 30 • Number 1 • 2018
Journal of Prosthetics and Orthotics
condition for each subject, and the casted mold was sent to the
brace manufacturer. The knee brace was constructed as per the
casted mold that was custom fit and adjustable. This orthosis
was set to vary at 4° and 7° valgus angles. The orthotist asked
the subjects to walk in the clinic and then adjusted the knee
valgus angle as per the comfort level of the patients. The sub-
jects were advised to wear the knee orthosis while performing
their daily activities.
LATERAL WEDGE FOOT ORTHOSIS
Full-length lateral wedge foot orthoses were made from a
cork composite (Thermocork; Aetrex Worldwide, Inc, Teaneck,
NJ) with a density of 60 durometers. An experienced orthotist
fitted the wedges to each subject during standing, walking,
and while wearing the valgus knee brace. The orthotist initially
evaluated the subjective influences of the lateral wedges using
two prefabricated full-length lateral wedges of 6 and 10 mm.
The purpose of having a maximum lateral wedge height was to
provide comfort to the subject. The foot orthosis with no wedge
was used for the nonaffected side. All subjects in the test condi-
tions were fitted with a pair of comfortable, identically styled
lightweight shoes pitched with a 1-inch heel height. Figure 1
demonstrates the valgus knee orthosis and lateral wedge insole
used in this study.
GAIT ANALYSIS
For each patient, gait analysis was conducted under two con-
ditions in the baseline and after 2 weeks of wearing the conser-
vative devices. Five walking trials were considered for each
condition. A Vicon digital motion capture system (Oxford Met-
rics, United Kingdom), using eight cameras (Vicon, Infrared)
at a frequency of 100 Hz, and two force platforms set apart and
positioned to capture a left and right heelstrike (Kistler 9286BA,
Switzerland) were used for capturing data. Fourteen markers
were placed bilaterally over the position of the greater trochanter,
Figure 1. Valgus knee orthosis (left side) and lateral wedge insole (right side) used in the study.
Volume 30 • Number 1 • 2018
Copyright © 2017 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited.
Valgus Knee Brace and Lateral Wedge Insole
lateral condyle of the femur, head and lateral malleolus of the
fibula, the second metatarsal, anterior superior iliac spine, and
calcaneus. The following parameters were analyzed: knee pain
levels (using the visual analog scale), sagittal plane hip, knee
and ankle joints range of motion (ROM), maximum externally
applied KAM, walking speed, cadence, and step length. The
means of the resulting data were calculated from both left and
right sides for the five walks using each device.
The external adduction moment about the knee was calcu-
lated by using inverse dynamics. Each lower-limb segment (foot,
shank, and thigh) was modeled as a rigid body with a local coor-
dinate system that coincided with anatomically relevant axes. In-
ertial properties of each limb segment were approximated
anthropometrically, and translations and rotations of each seg-
ment were reported relative to neutral positions defined during
the initial standing static trial. For each trial, the KAM waveform
was normalized to body weight and height (%BW*Ht) and
inspected visually. The peak magnitudes of the external KAM
in the first and second halves of stance were identified using
an algorithm that identified values immediately preceded by a
minimum of 5 continuously ascending values and followed by
a minimum of 5 continuously descending values.
SUBJECTIVE ASSESSMENT
Before the biomechanical evaluations, the patients were
evaluated regarding the quality of orthoses fitting and com-
fort. A visual analog scale (VAS) ranging from 0 (“no pain”)
to 10 (“worst pain imaginable”) was also used for pain assess-
ment when walking.
DATA ANALYSIS
Because of the normality of data (which was confirmed
using the Kolmogorov-Smirnov technique), a paired t test
was used for comparing the outcome measures of the inter-
group comparison. The univariate analysis was used for
41
Arazpour et al. Journal of Prosthetics and Orthotics

Table 1. Subjects demographic information who participated in this study

Lateral Wedge Insole Valgus Brace Valgus Brace Plus Lateral Wedge
No. Subjects 6 6 6 P
Age (yr) 54.50 (4.23) 55.16 (4.81) 53.17 (6.18) 0.085
Sex (female) 83.3% 50.0% 66.7% 0.162
Body mass index (kg/m2) 24.74 (2.46) 27.92 (5.40) 26.77 (0.51) 0.444
Mechanical axis angle of the knee joint (degree) 5.5 (1.87) 5.83 (1.47) 5.61 (1.64) 0.930
Pain at rest (VAS, 0–100) person-based 44.00 (19.69) 49.66 (24.60) 47.33 (22.30) 0.538
Kellgren-Lawrence grading scale for the dominant leg (II) 33.3% 33.3% 33.3% 1.000
(III) 66.7% 66.7% 66.7%

analyzing the efficacy of the intragroup comparison. SPSS statis- there was a significant difference in KAM and hip, knee, and an-
tical software was used for analysis of the data. The level of signif- kle joints ROM. There was no significant difference in the speed
icance was set at 0.05. of walking, cadence, and step length between with and without
intervention.

RESULTS INTRAGROUPS COMPARISON AND MEAN (SD) OF

The baseline data showed no significant differences in the
means of the age, sex, body mass index, or knee OA grade be-
tween the randomly assigned test groups (Table 1). The two
groups were therefore appropriately similar to facilitate the
comparison of the primary outcome measures. In addition,
Table 2 demonstrates the mean (SD) of the mentioned parameters
in the three test conditions with and without interventions.
Table 3 shows the intergroup and intragroup comparison of
the mentioned parameters in this study.
INTERGROUPS COMPARISON AND MEAN (SD) OF
MENTIONED PARAMETERS IN BASELINE
A significant difference was observed between with and with-
out interventions of lateral wedge insole with respect to KAM in
the lateral wedge group. There was a statistically significant dif-
ference favoring with and without interventions of the valgus
brace group and were noted for the KAM, speed of walking, ca-
dence, and knee joint ROM. There was no significant difference
in step length and hip and ankle ROM with and without inter-
vention. In the valgus brace plus lateral wedge insole group,
THE MENTIONED PARAMETERS IN BASELINE
The comparison between lateral wedge insole group and
valgus brace group revealed a significant difference in knee
joint ROM. There was no significant difference in residual
mentioned parameters (eg, pain, KAM, speed of walking, step
length, cadence, ankle joint ROM, and hip joint ROM). The
comparison between lateral wedge insole group with valgus
brace plus lateral wedge group showed a significant difference
in KAM, step length, speed of walking, and knee joint ROM.
There was no significant difference in pain, cadence, ankle joint
ROM, and hip joint ROM. The comparison between valgus brace
group and valgus brace and lateral wedge group showed a signif-
icant difference in KAM.
DISCUSSION
The results of this study provide the concept of using a valgus
knee brace and lateral wedge concurrently to enhance the mag-
nitude of decrease in the KAM.

Table 2. Mean (SD) of mentioned parameters in the three test conditions with and without interventions

Lateral Wedge Insole Valgus Brace Valgus Brace Plus Lateral Wedge
Preintervention Postintervention Preintervention Postintervention Preintervention Postintervention
Speed (m/s) 0.980 (0.105) 0.951 (0.157) 0.804 (0.258) 0.682 (0.264) 0.855 (0.270) 0.617 (0.139)
Cadence (stride/min) 49.55 (3.91) 47.43 (6.66) 46.75 (5.84) 41.81 (6.97) 47.70 (8.13) 41.36 (3.22)
Step length (m) 0.586 (0.042) 0.599 (0.028) 0.508 (0.117) 0.478 (0.133) 0.524 (0.092) 0.449 (0.084)
Hip ROM (degree) 45.25 (5.39) 44.68 (6.31) 42.63 (6.64) 40.66 (4.85) 43.53 (2.02) 38.71 (4.47)
Knee ROM (degree) 62.28 (5.53) 59.61 (5.31) 53.00 (12.23) 44.78 (8.47) 56.98 (11.60) 44.33 (6.95)
Ankle ROM (degree) 29.31 (4.67) 26.83 (4.04) 24.08 (2.60) 24.53 (2.34) 33.05 (4.01) 28.08 (4.98)
Pain (VAS) 44.00 (19.69) 22.50 (13.20) 49.66 (24.60) 24.16 (12.90) 47.33 (22.30) 18.50 (6.65)
KAM First Peak 3.41 (0.73) 2.95 (0.8) 3 (0.7) 2.41 (0.49) 3.25 (0.61) 2.36 (0.54)
(%BW*Ht)
Second Peak 2.80 (0.76) 2.33 (0.6) 2.25 (0.55) 1.76 (0.5) 2.46 (0.47) 1.63 (0.25)
(%BW*Ht)

42 Volume 30 • Number 1 • 2018

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Journal of Prosthetics and Orthotics Valgus Knee Brace and Lateral Wedge Insole

Table 3. Intergroup and intragroup comparison of mentioned parameters in this study

Intragroup Comparison* Intergroup Comparison**

P1 P2 P3 P4 P5 P6
Speed (m/s) 0.508 0.011 0.073 0.264 0.029 0.817
Cadence (stride/min) 0.142 0.021 0.120 0.548 0.301 1.000
Step length (mm) 0.326 0.059 0.112 0.419 0.045 0.738
Hip ROM (degree) 0.464 0.182 0.035 1.000 0.084 0.476
Knee ROM (degree) 0.060 0.038 0.001 0.002 0.000 0.546
Ankle ROM (degree) 0.061 0.662 0.014 1.000 1.000 0.477
Pain (VAS) 0.043 0.024 0.010 1.000 1.000 1.000
KAM First Peak (%BW*Ht) 0.000 0.013 0.000 0.445 0.02 0.045
Second Peak (%BW*Ht) 0.007 0.002 0.001 0.168 0.001 0.019

*Paired t-test analysis.

**Univariate analysis.
P value 1: Intragroup comparison between preintervention and postintervention in subjects with lateral wedge insole.
P value 2: Intragroup comparison between preintervention and postintervention in subjects with valgus brace.
P value 3: Intragroup comparison between preintervention and postintervention in subjects with lateral wedge insole and valgus brace.
P value 4: Intergroup comparison between lateral wedge insole group and valgus brace group.
P value 5: Intergroup comparison between lateral wedge insole group and valgus brace plus lateral wedge group.
P value 6: Intergroup comparison between valgus brace group and valgus brace plus lateral wedge group.

Three different teams of investigators have considered the
combined effects of knee braces and foot orthotics on walking
parameters in medial compartment knee OA. While evaluating
the combined effect of the rigid ankle foot orthoses and lateral
wedge insole in healthy subjects, Schmalz et al.23 reported
changes in the KAM during walking. Moyer et al.22 evaluated
the combined effect of the knee brace and orthotic foot inlay
on medial compartment knee OA and showed a reduction in
the KAM. In a recent randomized crossover trial, Hunter et al.24
evaluated the combined effect of wearing a valgus knee brace,
neutral foot orthosis, and motion control shoe. Their results
showed significant improvement in knee pain that was more
than the placebo treatment. Despite their positive effects, the
valgus unloader braces are also found to be associated with some
functional disadvantages. They can cause a significant reduction
in knee flexion during the swing phase. This restriction can re-
sult in reduced foot clearance and a shorter stride.20,25
The use of orthosis and lateral wedge separately and in com-
bination has been found to reduce step length as an immediate
effect after the wearing condition. The patients did not undergo
long accommodation time after wearing the two interventions.
Only 2 weeks of wearing the orthoses was considered for this
study. Similar to our study, Gaasbeek et al.25 reported the nega-
tive effects of knee braces on step length and stride length. They
demonstrated a decrease in the duration of the swing phase,
which would explain the decreased step and stride length during
walking with a brace. In contrast with our study, Schmalz et al.23
reported an increased value from 0.71 m (without brace condi-
tion) to 0.73 m (with orthosis) while the step length of the con-
tralateral limb reduced from 0.75 to 0.73 m.
Table 2 presents the speed of walking on immediately wear-
ing the lateral wedge and valgus knee brace, separately and
combined. The use of valgus knee brace reduced the hip, knee,
and ankle joints ROM, and the step length. Therefore, the speed
of walking reduced with immediate effect of the wearing condi-
tions. Compared with other knee OA participants in published
studies, the cohort in this study exhibited relatively slow gait
speed (the preintervention gait speed ranged from 0.804 to
0.980 m/s). All participations were grade 3 and 4 medial com-
partment knee OA in this study. The severity of cartilage com-
promise and resultant knee pain may explain the slow speed of
the subjects' ambulation. Schmalz et al.23 found that the mean
walking speed significantly increased from 1.27 m/s (without
brace) to 1.36 m/s (with orthosis). Gaasbeek et al.25 demon-
strated that patients with a valgus unloader brace walked at a
faster pace. In addition, Arazpour et al.26 found that the
speed of walking in baseline was 0.90 m/s, and after 6 weeks
of brace usage, it increased to 1.08 m/s. Pagani et al.27
showed that the average walking speeds in test conditions
without an orthosis, with 4° valgus angulation and a neutral
flexible test condition were 1.45 ± 0.15, 1.47 ± 0.12, and
1.45 ± 0.14 m/s, respectively.
The quality of life improvement of subjects with OA is consid-
ered important. However, the main aim of this conservative ap-
proach (combined knee orthosis and lateral wedge) is to reduce
the load in one knee compartment that would further decrease
the disease progression. Although the separate use of lateral
wedge and valgus knee orthosis have shown to efficiently de-
crease the subjective pain, their combined use has not been eval-
uated in their study.28 The findings of the present study provide
evidence that pain reduction and improvement of the function
are not necessarily associated with a decrease in joint load. It
seems that long-term wearing of these two interventions to-
gether can be effective for pain relief.

Volume 30 • Number 1 • 2018 43

Copyright © 2017 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited.
Arazpour et al.
STUDY LIMITATIONS
The main limitation of this study could be the small sample
size. This present study, being a pilot study, will lead to further
research with a large sample size. No control group was declared
without any intervention in this study. In addition, the patients
with only grade 2 and 3 OA were included in the study. Apart
from this, the long-term effects of using this intervention model
should be analyzed.
Not controlling for gait speed in the preintervention and
postintervention gait assessments is a major concern that may
potentially invalidate the study findings. Slowed gait speed will
reduce knee moments and ROM, as evidenced in data presented
in Table 2; hip, knee, and ankle ROM all decreased and KAM de-
creased. It is impossible to disentangle whether the KAM and
ROM reductions were a result of the biomechanical benefits of
the orthoses or slower gait speed. Future study in this field with
this goal will be beneficial.
CONCLUSIONS
The patients with medial compartment knee OA showed
lower walking velocity, reduced knee ROM, decreased cadence,
reduced step length and stride length, and increased peak varus
moments about the knee during the stance phase of walking in
the affected leg.
This study demonstrated that the use of either laterally
wedged insole or valgus knee brace separately or combined im-
prove knee pain in subjects with medial compartment knee OA,
but the combined wearing of these interventions was not more
effective in decreasing the pain compared with the separate
using of the lateral wedge and knee orthosis in this study. The
findings of the present study showed that the use of valgus knee
brace and lateral wedge insole can produce a greater overall re-
duction in KAM. The observed results demonstrated that wear-
ing two types of orthoses either separately or in a combined
condition does not improve the speed of walking, step length
and hip, knee, and ankle joints ROM.
ACKNOWLEDGMENT
We would like to thank the University of Social Welfare and Rehabilita-
tion Sciences for the financial support in this study.
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