Knee Osteoarthritis (OA), also known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage.
There are a range of orthotic intervention for OA knee pain. Knee bracing is a common intervention used and is considered to be conservative treatment.
Rest orthosis (knee immobiliser)
Taping
Knee sleeves
Unloader/Off-loader braces
Insoles (medial/lateral wedge)
Shock absorbing insoles
2. CONTENTS
• OSTEOARTHRITIS- INTRODUCTION
• ORTHOTIC APPROACH IN KNEE OA
• EFICACY OF REST ORTHOSIS
• EFFICACY OF SLEEVE KNEE SUPPORTS
• EFFICACY OF SLEEVE KNEE SUPPORTS WITH STABILIZING DEVICES
• EFFICACY OF HINGED KNEE BRACE
• KNEE MALALIGNMENT IN KNEE OA
• BIOMECHANICAL APPROACH BY UNLOADER KNEE BRACES
• UNLOADER KNEE BRACES
• FABRIC UNLOADER KNEE BRACE
• RIGID UNLOADER KNEE BRACE
• EFFICACY OF FOOT ORTHOSIS IN KNEE OA
• SHOCK-ABSORBING INSOLES
• LATERAL WEDGE INSOLES
• MEDIAL WEDGE INSOLES
3. OSTEOARTHRITIS
Knee Osteoarthritis (OA), also known as degenerative joint disease, is typically the result of wear and
tear and progressive loss of articular cartilage. Knee osteoarthritis can be divided into two types:
Primary : primary osteoarthritis is articular degeneration without any apparent underlying reason. This
is typically thought of as degeneration due to age.
Secondary: secondary osteoarthritis is the consequence of either an abnormal concentration of forces
across the joint with post-traumatic causes etc.
Possible causes of secondary OA :
• Post-traumatic
• Post-surgical
• Congenital or malformation of the limb
• Malposition (Varus/Valgus)
• Gout
• Rheumatoid Arthritis
5. ORTHOTIC APPROACH IN
OSTEOARTHRITIS
There are a range of orthotic intervention for OA knee pain. Knee bracing is a common
intervention used and is considered to be conservative treatment.
6. EFFICACY OF REST ORTHOSIS
REST ORHTOSIS:
• Rest orthosis are used for joint immobilization
which excludes any dynamic, corrective or
functional effect.
• The experimental basis for the use of rest orthosis
in lower limb OA is lacking. Our results of clinical
practice study among PMR physicians and
rheumatologists agree with this conclusion. Rest
orthosis is infrequently prescribed for knee and
ankle OA.
7. EFFICACY OF SLEEVE KNEE SUPPORTS
• These supports are used for mild knee OA and can
provide relief during increase activity, are usually
constructed of elastic material of neoprene.
• Design to offer circumferential pressure and
warmth with help in reducing swelling.
• Work as a kinesthetic reminder during physical
activities.
8. EFFICACY OF SLEEVE KNEE SUPPORTS
WITH STABILIZING DEVICES
• This type of brace is recommended with soft or
weak cartilage under the knee that causes pain.
• It relieves discomfort and helps keep the knee in
normal alignment.
• Knee sleeves with peripatellar alignment or
frontal stabilizing devices are used to have an
antalgic effect on knee OA along with additional
stability to the knee joint.
9. EFFICACY OF HINGED KNEE BRACE
For mild to moderated OA knee pain.
Soft material usage with addition of flexible or rigid
struts built on either sides
Efficacy works by providing:
• Gives similar compression and warmth due to
softer material usage in construction
• Additional side-to-side control for instability.
• Support the joint
• Allow the joint to heal
• Immobilization if required
10. KNEE MALALIGHNMENT
Knee joint OA with Varus Malalignment:
In knee joints with Varus malalignment, the ground
reaction force vector runs medially and from the
middle of the knee baseline.
Moment arm produces an external adduction moment
also named as Varus moment.
This adduction moment shifts the weight bearing line
medially within the knee
Increased medial compartment loading
11. BIOMECHANICAL APPROACH BY
UNLOADER KNEE BRACES
• Biomechanical consideration for orthotic
management:
Valgus unloading knee brace:
• applies bending moment at the knee joint, modifies
the knee joint alignment in coronal plane.
• It shifts the load from the medial compartment to
lateral compartment & reduces forces in the medial
compartment.
12. UNLOADER KNEE BRACES
Fabric unloader knee braces:
• These braces are used for moderate OA symptoms.
• They are hinged braces of fabric and elastic
construction which offer the ability to adjust the
alignment of knee brace to offload the painful
affected side of knee.
• Provide comfortable compressive support and
alignment improvements in gait for pain relief.
13. UNLOADER KNEE BRACES
Rigid unloading knee braces:
• These braces offer increased support from a
rigid frame for moderate to severe OA of the
knee.
• The three point pressure design of the brace
and rigidity provides effective support and
pressure relief of the affected joint space.
• The traditional valgus/ Varus knee brace
currently on the market could be divided into 2
types:
Single-hinged and double-hinged brace designs.
14. EFFICACY OF FOOT ORTHOSIS IN KNEE
MANAGEMENT
Insoles for lower limb in knee
OA
Shock-absorbing insoles Femoro-tibial unloading
insoles
Lateral wedge
insoles
Medial wedge
insoles
15. SHOCK-ABSORBING INSOLES
• Shock-absorbing insoles can be proposed foe hip of
knee OA majorly increasing the shock-absorbing
capacity during gait.
• Its mechanical action will significantly helps in
reducing negative impact at knee during arthritis
issues.
• Pain can significantly decreases as compared to no
foot orthoses.
16. FEMORO-TIBIAL UNLOADING INSOLES
Lateral wedge insoles:
Lateral wedge insoles are required for knee
OA with medial femoro-tibial compartment
involvement.
It creates valgus effect at the knee joint
thereby unloading the medial compartment.
17. FEMORO-TIBIAL UNLOADING INSOLES
Medial wedge insole:
Medial wedge insoles are required for knee
OA with lateral femoro-tibial compartment
involvement.
It creates Varus effect at the knee joint
thereby unloading the lateral compartment.
For patients with mild medial OA of the knee an insole can be used to improve overall lower limb alignment. With medial knee OA a laterally (outside of foot) wedged insole can help to reduce the pressure created at the inside knee joint during gait. These insoles can also be manufactured to aid with other OA linked foot and ankle pains. This is a low profile and easy to wear option for patients with mild symptoms.
