Is there an evidence-based efficacy for the use of foot orthotics in knee and hip osteoarthritis? Elaboration of French clinical practice guidelines.
OBJECTIVE
To develop clinical practice guidelines for the use of foot orthotics (FO) in the treatment of knee and hip osteoarthritis.


METHODS
The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic review of the literature, input from every day clinical practice and external review by a multidisciplinary expert committee, was used. The selected analysis criteria were pain, disability, medications used and X-ray evolution of osteoarthritis. The recommendations are classified according to the level of proof in Grade A, B or C according to the French National Agency for Health Accreditation and Evaluation (NAHAE).


RESULTS
In medial knee osteoarthritis, foot pronation orthotics--when there are no contraindications--can be proposed for their symptomatic impact, especially in the decrease of NSAIDs consumption (Grade B). To this day, there is no evidence of a structural or functional impact on osteoarthritis (Grade B). Outside of this specific clinical framework, there is no validated indication for prescribing foot orthotics in the treatment of knee or hip OA (Grade C).


CONCLUSIONS
It is necessary to have further randomized controlled trials to better define the indication of Foot orthotics (severity of knee OA, genu varum), test the efficacy of other orthoses such as cushioning FO. The long-term side effects, mainly on the external femorotibial compartment could also be assessed. A medical and economical assessment of FO prescriptions is also quite necessary.
Gélis
Anthony
A
Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Caremeau, Place du Pr Debré, 30029 Nîmes, France. anthony_gelis@yahoo.fr
Coudeyre
Emmanuel
E
Hudry
Christophe
C
Pelissier
Jacques
J
Revel
Michel
M
Rannou
François
F
D016206:Databases, Bibliographic; D019317:Evidence-Based Medicine; D005528:Foot; D005602:France; D006801:Humans; D009989:Orthotic Devices; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome