Unloading Shoes for Knee Osteoarthritis: A Clinical Study
Cinderella and arthritic knees
Mary Ann Forciea MD
September 22 2016
Source
•
Hinman, RS et al. Unloading Shoes for Self-
management of Knee Osteoarthritis. Ann Int
Med 2016. 165:381
•
Editorial: P 443
Background
•
OA of knee common, self management often
recommended
–
Weight loss, exercise, FOOTWEAR
•
Medial compartment loading greater, damage
greater
–
Unloading shoes: soles stiffer laterally than
medially reduce medial knee loads
•
Now available commercially
hypothesis
•
Unloading shoes will
–
Reduce pain
–
Improve physical function
–
At 6 months
–
Compared to convential ‘walking shoes’
method
•
2 group, parallel group, comparative
effectiveness RCT
•
Melbourne, 2013-2015
•
Eligible:
>50 yrs
knee pain on most days of prior month
average pain of 4 on 11 point scale in prior
week
XR evidence of OK and medial compartment
greater disease than lateral
Method 2
•
Exclude:
–
Lateral disease >medial
–
IA steroids or surgery in prior 3 months
–
Prior TKR or planned in 3 months
–
Systemic rheumatic illness
–
Other condition limiting lower leg use
–
Prior 6 month use of shoe inserts
–
Inability to walk unassisted
–
BMI >36
–
-pain in ankle or foot
Method 3
•
Randomized in blocks by radiographic severity
•
Shoes identical; everyone blind
•
Wear >4hr/day every day for 6 months
•
Log of hours – 7 consecutive days/month
•
Shoe mounted pedometer for step count
–
7 days in 4
th
week of months 2 and 5
Outcomes
•
Self reported pain scales 3 mo, 6 mo
–
NRS (clinically impt 1.8 points)
–
WOMAC function (MCID 6)
–
WOMAC pain (MCID) >18%
•
Harms – pain >2 days or required meds
Results
•
Matching good (Table 1) (slightly young for us)
•
Primary (Table 2): both groups improved in
primary, no meaningful difference @3 mo
–
Did wear shoes(7 hrs), little drop out(2%),
incorrect guessing
–
At 6 mo, improved function with unloading shoes,
not pain
•
Secondary no differences
Conclusions (authors)
•
No difference in shoe group for pain and
function
•
Both types did improved function, unloading
shoes better for pain
•
“Knee osteoarthritis symptoms may not be as
strongly influenced by abnormal biomechanics
as the literature suggests”
•
Of course subgroups might exist
Conclusions Mine
•
Both groups improved
–
Surprising number of steps/day for patients with
OA
•
I am unconvinced of clinical differences in any
outcome.
•
What is the influence of ‘special shoes’
whether walking shoes or unloading shoes?
•
Isn’t it the WALKING that helps?
In a study by Mary Ann Forciea MD, the use of unloading shoes was explored to manage knee osteoarthritis. The research focused on reducing pain and improving physical function in individuals with medial compartment disease. The randomized controlled trial conducted in Melbourne from 2013 to 2015 showed promising results at the 6-month mark. Participants wearing unloading shoes reported improved function without significant differences between groups at 3 months. The study highlights the potential benefits of using specialized footwear for knee osteoarthritis management.
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Presentation Transcript
Cinderella and arthritic knees Mary Ann Forciea MD September 22 2016
Source Hinman, RS et al. Unloading Shoes for Self- management of Knee Osteoarthritis. Ann Int Med 2016. 165:381 Editorial: P 443
Background OA of knee common, self management often recommended Weight loss, exercise, FOOTWEAR Medial compartment loading greater, damage greater Unloading shoes: soles stiffer laterally than medially reduce medial knee loads Now available commercially
hypothesis Unloading shoes will Reduce pain Improve physical function At 6 months Compared to convential walking shoes
method 2 group, parallel group, comparative effectiveness RCT Melbourne, 2013-2015 Eligible: >50 yrs knee pain on most days of prior month average pain of 4 on 11 point scale in prior week XR evidence of OK and medial compartment greater disease than lateral
Method 2 Exclude: Lateral disease >medial IA steroids or surgery in prior 3 months Prior TKR or planned in 3 months Systemic rheumatic illness Other condition limiting lower leg use Prior 6 month use of shoe inserts Inability to walk unassisted BMI >36 -pain in ankle or foot
Method 3 Randomized in blocks by radiographic severity Shoes identical; everyone blind Wear >4hr/day every day for 6 months Log of hours 7 consecutive days/month Shoe mounted pedometer for step count 7 days in 4thweek of months 2 and 5
Outcomes Self reported pain scales 3 mo, 6 mo NRS (clinically impt 1.8 points) WOMAC function (MCID 6) WOMAC pain (MCID) >18% Harms pain >2 days or required meds
Results Matching good (Table 1) (slightly young for us) Primary (Table 2): both groups improved in primary, no meaningful difference @3 mo Did wear shoes(7 hrs), little drop out(2%), incorrect guessing At 6 mo, improved function with unloading shoes, not pain Secondary no differences
Conclusions (authors) No difference in shoe group for pain and function Both types did improved function, unloading shoes better for pain Knee osteoarthritis symptoms may not be as strongly influenced by abnormal biomechanics as the literature suggests Of course subgroups might exist
Conclusions Mine Both groups improved Surprising number of steps/day for patients with OA I am unconvinced of clinical differences in any outcome. What is the influence of special shoes whether walking shoes or unloading shoes? Isn t it the WALKING that helps?
