Shakoor Najia, Lidtke Roy H, Wimmer Markus A, Mikolaitis Rachel A, Foucher Kharma C, Thorp Laura E, Fogg Louis F, Block Joel A
Rush Medical College, Chicago, Illinois 60612-3862, USA.
Arthritis Rheum. 2013 May;65(5):1282-9. doi: 10.1002/art.37896.
Biomechanical interventions for knee osteoarthritis (OA) aim to improve pain and retard disease progression by decreasing knee loading. This study was undertaken to evaluate the effects of 6 months of use of flat, flexible footwear (the mobility shoe) on knee loading in OA.
Subjects with knee OA underwent baseline gait analyses under conditions of walking in their own shoes, walking in mobility shoes, and walking barefoot. Thereafter, subjects wore the mobility shoes at least 6 hours per day for 6 days per week. Gait evaluations were repeated at 6, 12, and 24 weeks. An intent-to-treat analysis was performed to assess the longitudinal effects on knee loading with the shoe intervention.
Compared to knee loading at baseline with the participants' own shoes, there was an 18% reduction in the knee adduction moment (KAM) by 24 weeks with the mobility shoes (P < 0.001) and no significant differences in the KAM by 24 weeks between mobility shoe and barefoot walking (P = 0.192). Over the 6 months of followup, participants also experienced an 11% reduction in the KAM when walking in their own shoes (P = 0.002) and a 10% reduction in the KAM when walking barefoot (P = 0.002 for the whole followup), as compared to these values at baseline under the same conditions.
This study suggests that use of flat, flexible footwear results in significant reductions in knee loading in subjects with OA. By 24 weeks, there is evidence of a gait adaptation with sustained load reduction even when the mobility shoes are removed, suggesting that footwear may serve as a biomechanical training device to achieve beneficial alterations in gait mechanics for knee OA.
膝关节骨关节炎（OA）的生物力学干预旨在通过减轻膝关节负荷来改善疼痛并延缓疾病进展。本研究旨在评估6个月使用平底、柔软的鞋类（活动鞋）对OA患者膝关节负荷的影响。
膝关节OA患者在穿着自己的鞋子行走、穿着活动鞋行走和赤脚行走的条件下进行基线步态分析。此后，受试者每周6天每天至少穿6小时活动鞋。在第6、12和24周重复进行步态评估。进行意向性分析以评估鞋类干预对膝关节负荷的纵向影响。
与穿着患者自己的鞋子时的基线膝关节负荷相比，使用活动鞋24周时膝关节内收力矩（KAM）降低了18%（P<0.001），且24周时活动鞋行走和赤脚行走之间的KAM无显著差异（P = 0.192）。在6个月的随访中，与相同条件下的基线值相比，参与者穿着自己的鞋子行走时KAM也降低了11%（P = 0.002），赤脚行走时KAM降低了10%（整个随访期间P = 0.002）。
本研究表明，使用平底、柔软的鞋类可显著降低OA患者的膝关节负荷。到24周时，有证据表明即使去掉活动鞋，步态也会适应并持续减轻负荷，这表明鞋类可作为一种生物力学训练装置，以实现膝关节OA步态力学的有益改变。
