title: Changes in knee adduction moment, pain, and functionality with a variable-stiffness walking shoe after 6 months.
abstract: This study tested the effects of variable-stiffness shoes on knee adduction moment, pain, and function in subjects with symptoms of medial compartment knee osteoarthritis over 6 months. Patients were randomly and blindly assigned to a variable-stiffness intervention or constant-stiffness control shoe. The Western Ontario and McMaster Universities (WOMAC) score served as the primary outcome measure. Joint loading, the secondary outcome measure, was assessed using the external knee adduction moment. Peak external knee adduction moment, total WOMAC, and WOMAC pain scores were assessed at baseline and after 6 months. The total WOMAC and WOMAC pain scores for the intervention group were reduced from baseline to 6 months (p = 0.017 and p = 0.002, respectively), with no significant reductions for the control group. There was no difference between groups in magnitude of the reduction in total WOMAC (p = 0.50) or WOMAC pain scores (p = 0.31). The proportion of patients achieving a clinically important improvement in pain was greater in the intervention group than in the control group (p = 0.012). The variable-stiffness shoes reduced the peak knee adduction moment (-6.6% vs. control, p < 0.001) in the 34 intervention subjects at 6 months. The adduction moment reduction significantly improved (p = 0.03) from the baseline reduction. The constant-stiffness control shoe increased the peak knee adduction moment (+6.3% vs. personal, p = 0.004) in the 26 control subjects at 6 months. The results of this study showed that wearing the variable-stiffness shoe lowered the adduction moment, reduced pain, and improved functionality after 6 months of wear. The lower adduction moment associated with wearing this shoe may slow the rate of progression of osteoarthritis after long-term use.
authors.affiliation: Bone and Joint Center, Palo Alto VA, Palo Alto, California, 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: D000368:Aged; D018771:Arthralgia / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D007719:Knee Joint / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D054850:Osteophyte / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D010349:Patient Compliance; D011446:Prospective Studies; D012775:Shoes; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology