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Jul 20

Written by: Larry Huppin, DPM
7/20/2009 2:15 PM

Several studies advocate the use of laterally wedged foot orthoses for patients with medial knee OA.   The pathomechanics behind the function is to reduce the knee adduction moment and decrease load through the medial compartment. Lateral wedged insoles can reduce this moment.  Foot orthoses with lateral wedges have been shown to be more effective than lateral wedges alone.  This is likely due to the fact that the orthoses reduce STJ pronation and subsequent internal rotation of the tibia.  In addition, the orthoses help prevent collapse of the midtarsal joint that would otherwise likely occur with the use of lateral wedging.  

A pathology specific orthosis prescription for medial knee DJD would be as follows:

  • 3mm vacuum formed polypropylene with EVA arch fill (creates a flat bottom to the orthosis to allow addition of wedges - see below)
  • Standard heel cup
  • Standard width
  • Standard cast fill. 
  • Lateral heel skive
  • 0/0 flat rearfoot post (the post can be used later to add additional valgus wedging if needed). 
  • 2 degree valgus wedge extending length of the orthosis shell.   (this option is not on the Rx form - write it in under "special instructions)
To learn more about research on orthotic therapy, subscribe to our eJournal Club - a bi-weekly email summarizing recent research critical to the practice of orthotic therapy. 

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