Combined effects of knee brace, laterally wedged insoles and toe-in gait on knee adduction moment and balance in moderate medial knee osteoarthritis patients

Khan SJ 1 , Khan SS 2 , Usman J 3 , Mokhtar AH 4 , Abu Osman NA 5

Affiliations 

  • 1 Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Engineering, Riphah International University, Islamabad, Pakistan
  • 2 Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia; Centre for Applied Biomechanics, University of Malaya, Malaysia. Electronic address: juliana_78@um.edu.my
  • 4 Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 5 Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia; Centre for Applied Biomechanics, University of Malaya, Malaysia; The Chancellery, University of Malaysia Terengganu, Terengganu, Malaysia
Gait Posture, 2018 03;61:243-249.
PMID: 29413792 DOI: 10.1016/j.gaitpost.2018.01.024

Abstract

OBJECTIVE: To test the hypothesis that toe-in gait (TI) will further reduce first peak (Knee Adduction Moment) KAM and decrease balance when combined with a knee brace (KB) and laterally wedged insoles (LWI) in medial knee osteoarthritis (kOA) patients.
PARTICIPANTS: Twenty patients with bilateral symptomatic medial kOA.
INTERVENTIONS: 4-point leverage-based KB, full-length LWI with 5° inclination and toe-in gait (TI).
MAIN OUTCOME MEASURES: First and second peak knee adduction moment (fKAM and sKAM respectively), balance and pain.
METHODS: The fKAM and sKAM were determined from 3-dimensional gait analysis with six randomized conditions: (1) N (without any intervention), (2) KB, (3) KB + TI, (4) LWI, (5) LWI + TI, (6) KB + LWI + TI. Balance was assessed by Biodex Balance System using three stability settings, (i) Static (ii) Moderate dynamic setting for fall risk (FR12) and (iii) High dynamic setting for fall risk (FR8).
RESULTS: The reduction in fKAM and sKAM was greatest (19.75% and 12%) when TI was combined with KB and LWI respectively. No change in balance was observed when TI combined with KB, and LWI and when used concurrently with both the orthosis at static and FR12 conditions. Significant balance reduction was found at FR8 for KB + TI (22.22%), and KB + LWI + TI (35.71%). Pain increased significantly for KB (258%), KB + TI (305%), LWI + TI (210%) and KB + LWI + TI (316%). LWI showed no effect on pain.
CONCLUSIONS: There is a synergistic effect of TI when combined with KB and LWI concurrently in sKAM reduction. However, the concurrent use of TI, KB and LWI decreases balance and pain as assessed on a highly dynamic platform.
Study site: Department of Sports Medicine, University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

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