title: Effects of a novel foot-ankle orthosis in the non-operative treatment of unicompartmental knee osteoarthritis.
abstract: BACKGROUND
  Unloader braces are non-surgical treatment options for patients with unicompartmental knee osteoarthritis (OA). However, many patients do not adhere to brace treatment because of complications related to discomfort and poor fit. An alternative to knee bracing is an ankle-foot orthosis (AFO) with a lever arm that presses the lower leg into valgus or varus. The aim of this study is to evaluate the clinical benefits of this AFO for patients with unicompartmental knee OA.
  
  
  METHODS
  Twenty-three patients with knee OA were enrolled in this observational study. The primary clinical outcome measure was the Western Ontario and McMasters Universities Arthritis Index (WOMAC) total score. Secondary outcome measures included WOMAC subscores, visual analogue pain scale, activity restriction and complication rate. Clinical scores were collected at start and 3, 6, 9, and 12 months after enrollment. Statistical evaluation was performed using the Student's t test.
  
  
  RESULTS
  Of the patients enrolled, 83 % suffered from medial compartment OA. Most patients had Grade II OA according to the Kellgren and Lawrence classification. WOMAC total score, both subscores and visual analogue pain scale were significantly improved over time. Patients also noted a reduction in restrictions to activities of daily living and sport-related activities while using the AFO. No patients discontinued orthosis use because of adverse effects. Two types of complications were noted: discomfort or light pressure sores around the ankle (7 patients), and wear and tear of the shoe in which the AFO was worn (14 patients).
  
  
  CONCLUSIONS
  This observational study suggests that this AFO is effective at significantly reducing pain and stiffness as well as improving the physical function of patients with mild to moderate unicompartmental osteoarthritis of the knee.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, School of Medicine, University of Göttingen, Göttingen, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Menger
authors.affiliation: Otto Bock Health Care, Duderstadt, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kannenberg
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Germany. wolf.petersen@pgdiakonie.de.
authors.forename: Wolf
authors.identifier: http://orcid.org/0000-0002-6834-4438
authors.initials: W
authors.lastname: Petersen
authors.affiliation: Sporthopaedicum Straubing, Straubing, Germany.
authors.forename: Thore
authors.initials: T
authors.lastname: Zantop
authors.affiliation: Deutsche Sporthochschule Köln, Cologne, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Rembitzki
authors.affiliation: Orthopaedicum Northeim, Northeim, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Stinus
mesh_terms: D000203:Activities of Daily Living; D015331:Cohort Studies; D005260:Female; D061826:Foot Orthoses; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000145:classification / Q000628:therapy*; D010147:Pain Measurement
keywords: Knee adduction moment; Malalignment; Non-operative treatment; Osteoarthritis; Unloader brace; Varus knee