title: A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis.
abstract: The purpose of this study was to evaluate the effectiveness of variable-stiffness shoes in lowering the peak external knee adduction moment during walking in subjects with symptomatic medial compartment knee osteoarthritis. The influence on other lower extremity joints was also investigated. The following hypotheses were tested: (1) variable-stiffness shoes will lower the knee adduction moment in the symptomatic knee compared to control shoes; (2) reductions in knee adduction moment will be greater at faster speeds; (3) subjects with higher initial knee adduction moments in control shoes will have greater reductions in knee adduction moment with the intervention shoes; and (4) variable-stiffness shoes will cause secondary changes in the hip and ankle frontal plane moments. Seventy-nine individuals were tested at self-selected slow, normal, and fast speeds with a constant-stiffness control shoe and a variable-stiffness intervention shoe. Peak moments for each condition were assessed using a motion capture system and force plate. The intervention shoes reduced the peak knee adduction moment compared to control at all walking speeds, and reductions increased with increasing walking speed. The magnitude of the knee adduction moment prior to intervention explained only 11.9% of the variance in the absolute change in maximum knee adduction moment. Secondary changes in frontal plane moments showed primarily reductions in other lower extremity joints. This study showed that the variable-stiffness shoe reduced the knee adduction moment in subjects with medial compartment knee osteoarthritis without the discomfort of a fixed wedge or overloading other joints, and thus can potentially slow the progression of knee osteoarthritis.
authors.affiliation: Bone and Joint Center, Palo Alto VA, Palo Alto, CA, USA. jerhart@stanford.edu
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Erhart
authors.forename: Annegret
authors.initials: A
authors.lastname: Mündermann
authors.forename: Barbara
authors.initials: B
authors.lastname: Elspas
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Giori
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Andriacchi
mesh_terms: D003198:Computer Simulation; D004548:Elasticity; D019544:Equipment Failure Analysis; D005260:Female; D020233:Gait Disorders, Neurologic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009989:Orthotic Devices; D020370:Osteoarthritis, Knee / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000534:rehabilitation*; D011474:Prosthesis Design; D012775:Shoes; D019415:Torque; D016896:Treatment Outcome