title: Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis.
abstract: The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17-0.52, p<0.001) were observed during stair descent; and significant increases in the EKFM were observed during stair ascent (0.54, 95%CI: 0.30-0.78, p<0.001) and descent (1stpk: 0.48, 95%CI: 0.15-0.80, p=0.005; 2ndpk: 0.55, 95%CI: 0.34-0.76, p<0.001). Fewer gait compensations were observed between conditions during stair descent compared to ascent, except for toe out. Findings suggest greater effects on gait when both knee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes.
authors.affiliation: School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada. Electronic address: rebecca.moyer@dal.ca.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Moyer
authors.affiliation: Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada. Electronic address: tbirming@uwo.ca.
authors.forename: Trevor
authors.initials: T
authors.lastname: Birmingham
authors.affiliation: Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: Dombroski
authors.affiliation: Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Walsh
authors.affiliation: Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada; Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
authors.forename: J Robert
authors.initials: JR
authors.lastname: Giffin
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena / Q000502:physiology*; D003131:Combined Modality Therapy; D005260:Female; D033023:Foot Joints / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000534:rehabilitation*; D000072799:Stair Climbing; D000072797:Walking Speed / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology
keywords: Biomechanics; Knee osteoarthritis; Lateral wedge orthotic; Stairs; Valgus knee brace