Choosing Wisely:

Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.

Rationale and Comments: In patients with symptomatic osteoarthritis of the knee, the use of lateral wedge or neutral insoles does not improve pain or functional outcomes. Comparisons between lateral and neutral heel wedges were investigated, as were comparisons between lateral wedged insoles and lateral wedged insoles with subtalar strapping. The systematic review concludes that there is only limited evidence for the effectiveness of lateral heel wedges and related orthoses. In addition, the possibility exists that those who do not use them may experience fewer symptoms from osteoarthritis of the knee.
Sponsoring Organizations:
  • American Academy of Orthopaedic Surgeons
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Orthopedic
  • References: • American Academy of Orthopaedic Surgeons. Clinical practice guideline on the treatment of osteoarthritis of the knee (non-arthroplasty). Rosemont (IL): American Academy of Orthopaedic Surgeons, 2008 Dec. Available from: http://www.aaos.org/research/guidelines/OAKguideline.pdf.
    • Baker K, Goggins J, Xie H, Szumowski K, Lavalley M, Hunter DJ, Felson DT. A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis Rheum. 2007;56(4):1198-203.
    • Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A, Hanna F, Davies-Tuck M, Harris A, Hinman RS. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomized controlled trial. BMJ. 2011;342:d2912.
    • Brouwer RW, Jakma TS, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev. 2005;1:CD004020.
    • Maillefert JF, Hudry C, Baron G, Kieffert P, Bourgeois P, Lechevalier D, Coutaux A, Dougados M. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study. Osteoarthritis Cartilage. 2001;9(8):738-45.
    • Nigg BM, Emery C, Hiemstra LA. Unstable shoe construction and reduction of pain in osteoarthritis patients. Med Sci Sports Exerc. 2006;38(10):1701-8.
    • Pham T, Maillefert JF, Hudry C, Kieffert P, Bourgeois P, Lechevalier D, Dougados M. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis. A two-year prospective randomized controlled study. Osteoarthritis Cartilage. 2004;12(1):46-55.
    • Richmond J, Hunter D, Irrgang J, Jones MH, Levy B, Marx R, Snyder-Mackler L, Watters WC, Haralson RH, Turkelson CM, Wies JL, Boyer KM, Anderson S, St Andre J, Sluka P, McGowan R; American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee (nonarthroplasty), JAAOS. 2009;17(9):591-600.
    • Toda Y, Segal N, Kato A, Yamamoto S, Irie M. Effect of a novel insole on the subtalar joint of patients with medial compartment osteoarthritis of the knee. J Rheumatol. 2001;28:2705-10.
    • Toda Y, Tsukimura N. A comparative study on the effect of the insole materials with subtalar strapping in patients with medial compartment osteoarthritis of the knee. Mod Rheumatol 2004;14(6):459-65.
    • Toda Y, Segal N. Usefulness of an insole with subtalar strapping for analgesia in patients with medial compartment osteoarthritis of the knee. Arthritis Rheum. 2002;47:468-73.
    • Toda Y, Tsukimura N. A six month follow-up of a randomized trial comparing the efficiency of a lateral-wedge insole with subtabalar strapping and in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee. Arthritis Rheum. 2004;50:3129-36.
    • Toda Y, Tsukimura N. A 2-year follow-up of a study to compare the efficiency of lateral-wedged insoles with subtalar strapping and in-shoe lateral-wedged insoles in patients with varus deformity osteoarthritis of the knee. Osteoarthritis Cartilage. 2006;14:231-7.

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