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Wedged Insoles for the Arthritic Knee

Lanny L. Johnson, M.D.


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Information for the informed buyer US Patent 8,122,550

These wedged insoles have the potential of being a real benefit for the most common arthritic problem of the knee; those people with localized problem only on the inner side.


Patient with loss of cartilage on inner side of both knees and bowed legs

Standing x-ray of the left knee

The arthritic condition is often associated with a bowed leg on the same side due to loss of the cartilage between the bones. The x-ray as shown here has a narrowed inner joint space with bone on bone due to loss of the articular cartilage.



Knocked knee

Knocked Knees and isolated outer side arthritis: Dr. Lanny's insoles may also be helpful for those with isolated outer side knee compartment problems. A knocked knee appearance may accompany this condition as see in this photograph. If this is your situation, localized outer knee compartment arthritis with accompanying knocked knee then, skip down for the instructions.

**These wedged insoles are not indicated for those with patellar arthritis or diffuse arthritis of the knee.

FAQ's for Inner Side Arthritis of the knee

Will our wedged insoles work for you?

Yes, if you, the arthritic patient, meet the following important criteria.

Quick and Easy Self Evaluation: In the interest of your time and money, you can find out if these wedged insoles will work for you.

You will learn if you are a candidate to be helped in far less time than driving to the doctor's office and reading his/her magazines in the waiting room before being examined.

Before you buy, the following conditions are necessary for these wedged insoles to benefit you.

  1. You have arthritis in the inner side of your knee.
  2. You have ability to straighten your knee within a few degrees of straight.
  3. You have the ability to bend your knee past 90 degrees.
  4. Your knee joint plus foot and ankle are very pliable or in medical terms they have passive mobility as determined by the following tests.

Test #1: Making sure there is passive laxity of the inner knee ligament; the medial collateral ligament.

You sit in a chair with your knees bent to 90 degrees as shown below.

You then pull your knees together as shown below.

If you are able to pull your knees together so they touch as well as the ankles, you are ready to do the test.

You then straighten both legs while keeping the knees and ankles touching each other as shown below.

This person is sitting with knees extended, yet the knees and feet are touching each other.

If you were able to do this maneuver, you have met the first criteria for use of wedged insoles for inner knee conditions; pliable inner knee ligaments.

FAILURE: If you were unable to successfully compete this test, then repeating this exercise 3 times per day for a few days will loosen up the ligaments about your knee. When you are able to do this test successfully, you may be ready for use of the wedged insoles, providing you are able to accomplish Test #2.

Test #2: This is a simple test to establish if there is enough "play" or laxity in your foot and ankle to allow the wedged insole to shift forces from the floor and transmit the force up your shin bone to your knee.

In medical terms, this test is necessary to confirm the wedged insole with elevation on the lateral side would result in translation of the forces up the tibia (leg bone), thereby creating a valgus moment (inward movement of the knee) to the knee that has passive laxity (looseness) of the medial (inner) collateral knee ligament.

You are to assume the sitting position and cross your legs while maintaining your feet flat on the floor as shown below.

If you are able to do this and Test #1 you have confirmed the indications are in place for you to benefit from the use of our dynamic wedged insole in your shoe with the high side under the outer part of your foot.

Let us review: Our insoles will work for your arthritic knee if your arthritis is localized to just the inner or outer side. If your arthritis is in all areas of your knee or you cannot straighten or bend your knee very well you should see a physician to evaluate your options.

In order to learn if our wedged insoles will help your arthritic knee, you need to have a flexible foot and ankle as well as some pliability of your knee as explained above.

Golfers with knee problems are referred to www.GolfersKnee.com for more information.

Controversy: There is a controversy concerning the benefit of wedged insoles in the medical literature. Some reports say they work and others say they do not. A careful review of these publications did not reveal a consideration of the important factors of compliance of the patient's foot and ankle or passive laxity of the knee that we have just explained. Since these factors were not considered or included in any study, it is not surprising that the results were mixed. Even Bennell's, et al, excellent study did not consider these critical factors for success and therefore did not find a positive result.

Insole Design Choices

Clarification before Purchasing: There are three types of insoles as described below. There are two insoles in each package.

Wedged Insoles: There are two types of wedged insoles: the 2.5 degree and 5.0 degree. See below for explanation.

Comfort or Balance Insoles:

Comfort: The Neutral Balanced insoles for those who without knee problem just want the best possible insole for comfort. That is the Neutral Balance. Offered for sale here.

Balance: The Neutral Balance is also purchased by those that have only one side involvement. They place the Neutral Balanced in their shoes on the unaffected side in order to have balance during walking. This insole will provide comfort and balancing of extremity lengths when placed under the existing insole of the shoe of the unaffected side. This avoids the feeling of stepping in hole with the unaffected side during walking. If both knees are affected then wedged insoles are used on both sides and the neutral balanced insole is not necessary.

Specifications of Contents: Each package has the indicated insole contents. The insoles are 14 inches long, 4 1/4 inches wide and have a minimum depth of 1/8 inch. The material is Poron® for Neutral Balance or Polyvinylacetate (PVA) of selected density for the wedged insoles. All packages are labeled, color coded, with enclosed patterns for left and right foot. This web site has the ILLUSTRATED INSTRUCTIONS for fitting to your foot and your shoes.


Pattern for Preliminary Tailoring the Final Insole to your Foot and Shoe

Package #1: This is a good place to start. This size may be all that is ever necessary for some people. This 2.5 degree (blue colored) insole is for the person with isolated inner or outer compartment problems of the knee. It contains two 2.5 degree (blue colored) Wedged Cushioned Insole forms. Proven function by independent testing to reduce the peak axial force across the inner or outer knee compartment with proper placement. See www.GolfersKnee.com for study graphs on results.

If your involvement is one sided then you may want to purchase the Neutral Balanced insole for the unaffected side.


Out of Package view of the two 2.5 degree wedged insoles

Close-up of end of Wedge

This package may also be purchased for fitting other shoes or replacement and offered for sale here.


Insoles in the Package with Instructions and Pattern for Cutting

This package may also be purchased for fitting other shoes or replacement and offered for sale here.

Package #2: These wedged insoles are for the larger person or those workers or sportsmen who are very active. This package has two 5 degree (green colored) Wedged Cushioned Insole forms. Proven function by independent testing to reduce the peak axial force across the inner or outer knee compartment with proper placement. See www.GolfersKnee.com for study graphs on results.

If your involvement is one sided then you may want to purchase the Neutral Balanced insole for the unaffected side.


Two 5 degree Wedged insoles out of Package

Two 5 degree Wedged insoles in Package with Instructions and Pattern

This package may also be purchased for fitting other shoes or replacement and offered for sale here.

Outer Side Localized Knee Compartment Arthritis

Those patients with outer side arthritis will need to confirm similar criteria as those with inner side problems. Your knee joint must be flexible. You should sit in a chair with both knees and ankles together as shown below.

This may not be possible at first due to the tight lateral side ligament of your knee. If not possible, then assume the same position with the knees together and use a belt to gradually pull your ankles together. This may be done 3X a day until you stretch the outer knee ligaments. Do not try to do this all at once. Do not cause any pain in your knee with the tightening, just do it gradually over time.

When you are able to have the knees and ankles together in the sitting position then straighten your knees. If the outer knee ligaments are now stretched you will be able to hold your knee and ankles together as shown below.

Now that the outer knee ligaments are compliant, you need to make sure that there is the necessary flexibility of your foot and ankle.

This flexibility is established by sitting in a chair, keeping your knees together and moving your foot to the side, all the while keeping the foot flat on the floor as shown below.

This position confirms that the outer side of your foot and ankle is flexible enough to respond to the wedged insole with the higher side under the inner side of your foot.

You are now ready to consider use of the wedged insole for outer knee compartment arthritis.

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Caution: Not intended for individuals with severe foot or ankle problems. Not intended for those with diabetic or neurological problems. Not intended for those with severe foot deformities or those who suffer from circulatory diseases that result in infections or ulcerations on the bottom of the feet. Not intended for neurological problems or for purposes other than stated.


Easy to fit to your shoe

Insole Fitting Instructions

INNER KNEE PROBLEM: HIGH SIDE TO OUTSIDE OF SHOE

OUTER KNEE PROBLEM: HIGH SIDE TO INSIDE OF SHOE

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90 Day Money Back Guarantee

In the unlikely event that you are not completely satisfied with your purchase, you may return the product UNALTERED IN THE ORIGINAL PACKAGE for a full refund less shipping costs.

Product Return Procedure

To return a product and obtain a refund, use the Contact Us page to obtain a Return Merchandise Authorization (RMA) number. This request must include your order number and must be submitted within 90 days of purchase date.

Your RMA number must be displayed on the shipping label of boxes containing the returned product.

You are solely responsible for shipping any returned product. COD shipments will not be accepted.

Refunds will be issued after returned product is received and the UNALTERED CONDITION confirmed. Shipping charges will not be refunded.

References — Wedge Insoles in Knee Joint Arthritis

Bennell KL, Bowles KA, Payne C et al. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ 2011;342):d2912. PM:21593096

Baker K, Goggins J, Xie H et al. A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis Rheum 2007;56(4):1198-1203. PM:17393448

Maillefert JF, Hudry C, Baron G et al. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study. Osteoarthritis Cartilage 2001;9(8):738-745. PM:11795993

Pham T, Maillefert JF, Hudry C et al. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis. A two-year prospective randomized controlled study. Osteoarthritis Cartilage 2004;12(1):46-55. PM:14697682

Fang MA, Taylor CE, Nouvong A, Masih S, Kao KC, Perell KL. Effects of footwear on medial compartment knee osteoarthritis. J Rehab Res Dev. 2006.43(4);427-434.

Perhaps the most convincing evidence of the dynamic benefit of a lateral wedge in patients with medial arthritis was the statement by Kerrigan, et al., "These data imply that wedged insoles are biomechanically effective and should reduce loading of the medial compartment in persons with medial knee osteoarthritis."

Kerrigan DC, Lelas JL, Goggins J, Merriman GJ, Kaplan RJ, Felson DT. Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis. Arch Phys Med Rehabil. 2002 Jul;83(7):889-93.

The Federal Government NIH is also interested in this type of treatment method and has funded research in this area.

LLJMD, LLC is not responsible for the privacy policy, the content or the accuracy of any website accessed through a link on DrLannysInsoles.com. A link to other websites does not constitute an endorsement by LLJMD, LLC of the linked site, its products or services.

American Academy of Orthopaedic Surgeons' Recommendation

The American Academy of Orthopaedic Surgeons recent recommendation on the "Treatment of Osteoarthritis of the Knee", 2nd edition makes the following statements concerning the use of lateral wedges for medial compartment arthritis of the knee.

It should be noted that there was no consideration given by AAOS or the references to the necessary inclusion criteria of subtalar motion and knee joint ligament compliance.

RECOMMENDATION 5

We cannot suggest that lateral wedge insoles be used for patients with symptomatic medial compartment osteoarthritis of the knee. Strength of Recommendation: Moderate

Description: Evidence from two or more "Moderate" strength studies with consistent findings, or evidence from a single "High" quality study for recommending for or against the intervention. A Moderate recommendation means that the benefits exceed the potential harm (or that the potential harm clearly exceeds the benefits in the case of a negative recommendation), but the quality/applicability of the supporting evidence is not as strong.

Implications: Practitioners should generally follow a Moderate recommendation but remain alert to new information and be sensitive to patient preferences.

RATIONALE

This recommendation is based on five studies. Four studies, one of high-strength and three of moderate-strength, compared outcomes using lateral wedge insoles to neutral insoles. No significant changes in pain, self-reported physical function, or Patient Global Assessment scores were seen between the two types of insoles. A fifth low-strength study compared urethane lateral wedge insoles to rubber lateral insoles, and found a statistically significant improvement in Lequesne score for urethane insoles, but this outcome was of uncertain clinical significance.

Treatment of Osteoarthritis of the Knee, 2nd edition

SUMMARY OF RECOMMENDATIONS

This summary of the AAOS clinical practice guideline, "Treatment of Osteoarthritis of the Knee" 2nd edition, contains a list of the evidence based treatment recommendations and includes only less invasive alternatives to knee replacement. Discussion of how each recommendation was developed and the complete evidence report are contained in the full guideline at www.aaos.org/guidelines. Readers are urged to consult the full guideline for the comprehensive evaluation of the available scientific studies. The recommendations were established using methods of evidence-based medicine that rigorously control for bias, enhance transparency, and promote reproducibility.

This summary of recommendations is not intended to stand alone. Medical care should be based on evidence, a physician's expert judgment and the patient's circumstances, values, preferences and rights. For treatment procedures to provide benefit, mutual collaboration with shared decision-making between patient and physician/allied healthcare provider is essential.

www.aaos.org/Research/guidelines/OAKSummaryofRecommendations.pdf

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