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Nov 3

Written by: Cherri Choate, DPM
11/3/2010

Knee pain is one of the most common medical complaints related to the lower extremities. With growing numbers of people over the age of 60, knee pain is likely to be a bigger issue in the coming decades. The impact of shoes and orthotics on the motion of the knee should be recognized. Medial knee compartment osteoarthritis is the most common location for arthrtiis in the knee joint. Although the health care system spends a great deal of money on addressing knee arthritis once it is present, it would be better to consider how this problem may develop and intervene early in the process. The players in this process include many intrinsic and extrinsic factors:  anatomic knee position, anatomic knee motion, weight, activity, shoe type, heel height, over-the-counter shoe inserts and custom orthotics. This list is simplified, but it speaks to the many factors that may lead to knee osteoarthritis. 

An article published in 2008 by Franz et al. reports the effect of soft shoe inserts which mimic a small varus wedge, on the medical forces through the knee. Even this soft insert increased the forces through the medial knee by up to 4% during running and 6% during walking.  Interestingly, prior studies on shoes have shown that  heel heights have an even greater influence. This same group headed by Franz found that by increasing a heel height to 2.8 inches, the medial knee forces increased by 23-26% during walking. In addition a study by Williams et al. in 2003 showed that rigid custom orthotics inverted by 15-25 degrees increased medial knee torques by up to 27% during running. 

It appears that the knee is highly influenced by both internal and external forces. As a practitioner our awareness should be heightened to this sensitivity and our treatment should be adjusted accordingly. Perhaps more attention should be given to  knee pain complaints, family history of knee pain, obesity, age, shoe style, heel height, running surface, OTC insoles and previous orthotic history. All this information will lead to increased patient treatment success both now and in future years as the knee undergoes wear and tear with every step.

Interested in learning more?  Read the EJournal summary for the following article:

Franz JR, Dicharry J, Riley PO, et al. The Influence of Arch Supports on Knee Torques Relevant to Knee Osteoarthritis. Med Sci Sports Exerc 40(5):913-7, 2008.

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