Butler Robert J, Marchesi Stephanie, Royer Todd, Davis Irene S
Department of Physical Therapy, University of Evansville, 1800 Lincoln Avenue, Evansville, Indiana 47722, USA.
J Orthop Res. 2007 Sep;25(9):1121-7. doi: 10.1002/jor.20423.
We examined if a subject-specific amount of lateral wedge added to a foot orthosis could alter knee mechanics to potentially reduce the progression of knee osteoarthritis in patients with medial knee osteoarthritis. Twenty individuals with medial knee osteoarthritis (>/=2 Kellgren Lawrence grade) were prescribed a custom laterally wedged foot orthotic device. The prescribed wedge amount was the minimal wedge amount that provided the maximum amount of pain reduction during a lateral step-down test. Following an accommodation period, all subjects returned to the laboratory for a gait analysis. Knee mechanics were collected as the subjects walked at an intentional walking speed. Walking in the laterally wedged orthotic device significantly reduced the peak adduction moment during early stance (p < 0.01) compared to the nonwedged device. Similarly, the wedged orthotic device significantly reduced the knee adduction excursion from heel strike to peak adduction (p < 0.01) compared to the nonwedged device. No differences in the peak adduction moment during propulsion or peak adduction during stance were observed between the orthotic conditions. A subject-specific laterally wedged orthotic device was able to reduce the peak knee adduction moment during early stance, which is thought to be associated with the progression of knee osteoarthritis. Previous studies on this device have reported issues associated with foot discomfort when using wedge amounts >7 degrees; however, no such issues were reported in this study. Therefore, providing a custom laterally wedged orthotic device may potentially increase compliance while still potentially reducing disease progression.
我们研究了在足部矫形器中添加特定个体所需的外侧楔形物是否能够改变膝关节力学，从而有可能减缓内侧膝关节骨关节炎患者膝关节骨关节炎的进展。二十名内侧膝关节骨关节炎患者（Kellgren Lawrence分级≥2级）被定制了一种外侧带楔形物的足部矫形装置。所规定的楔形物量是在外侧下台阶试验中能最大程度减轻疼痛的最小楔形物量。经过适应期后，所有受试者返回实验室进行步态分析。当受试者以有意的步行速度行走时，收集膝关节力学数据。与无楔形物的装置相比，穿着外侧带楔形物的矫形装置行走时，在早期站立阶段的内收力矩峰值显著降低（p<0.01）。同样，与无楔形物的装置相比，带楔形物的矫形装置在从足跟触地到内收峰值期间的膝关节内收偏移也显著降低（p<0.01）。在不同矫形条件下，推进期的内收力矩峰值或站立期的内收峰值均未观察到差异。一种根据个体定制的外侧带楔形物的矫形装置能够降低早期站立阶段的膝关节内收力矩峰值，而这被认为与膝关节骨关节炎的进展有关。此前关于该装置的研究报告称，使用楔形物量>7度时会出现与足部不适相关的问题；然而，本研究中未报告此类问题。因此，提供一种根据个体定制的外侧带楔形物的矫形装置可能会提高依从性，同时仍有可能减缓疾病进展。
