The Effects of Unloader Knee Orthosis and Lateral Wedge Insole in Patients with Mild and Moderate Knee Osteoarthritis (OA)

Objective: Patients suffering from mild to moderate knee osteoarthritis may be treated with unloader knee orthoses or laterally wedged insoles. This study aimed to identify and compare the effects of two orthoses in these patients. Methods: 56 patients with medial compartment knee OA were evaluated when wearing an unloader knee orthosis and insoles with a 6° lateral wedge which were randomly assigned. Testing was performed at baseline and after 6 months of use with the two types of orthoses. The KOOS score was used to assess outcomes in this study. A paired T test was used for comparing base line and the 6th month post interventions KOOS sub scale score. An independent T test was used for analyzing the efficacy between the two orthoses. Results: Each of the interventions improved all the parameters comparing to the baseline condition (P=0.000). However, in comparing the effect between these orthoses, we did not find significant differences in activities of daily living (P=0.871), or sports and recreational activities (P=0.351). The pain and symptoms (P=0.000) were, however, significantly different between the two interventions. Conclusion: The unloader knee orthoses were more effective than lateral wedge insoles in reducing pain and symptoms

Orthoses for Spinal Cord Injury Patients

There are some limitations for patients with spinal cord injury (SCI) when walking with assistive devices. Heavy energy expenditure and walking high loads on the upper limb joints are two main reasons of high rejection rate of orthosis by these patients . Many devices have been designed to enable people with paraplegia to ambulate in an upright position as a solution of these limitations such as mechanical orthoses, hybrid orthoses and powered orthoses. All these devices are designed to solve the problem of standing and walking, but there are some other important notes, which should be considered. For example, the size and weight of external orthoses, donning and doffing, cumbersomeness and independency for using are very important

The physiological cost index of walking with a powered knee ankle foot orthosis in subjects with poliomyelitis : A pilot study

Background: A powered knee ankle foot orthosis (KAFO) was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. Objectives: The purpose of this study was to determine its effect on the physiological cost index (PCI), walking speed and the distance walked in people with poliomyelitis compared to when walking with a KAFO with drop lock knee joints. Methods: Seven subjects with poliomyelitis volunteered for the study, and undertook gait analysis with both types of KAFO. Results: Walking with the powered KAFO significantly reduced walking speed (p=0.015) and the distance walked (p=0.004), and also it did not improve PCI values (p =0.009) compared to walking with the locked KAFO. Conclusion: Using a powered KAFO did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects

Evaluation of gait symmetry in poliomyelitis subjects : Comparison of a conventional knee ankle foot orthosis (KAFO) and a new powered KAFO.

Background: Compared to able-bodied subjects, subjects with post polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry. Objectives: The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop- locked knee ankle foot orthosis (KAFO) or a newly developed powered KAFO. Methods: Seven subjects with poliomyelitis who routinely wore conventional KAFOs participated in this study, and received training to enable them to ambulate with the powered KAFO on level ground, prior to gait analysis. Results: There were no significant differences in the gait symmetry index (SI) of step length (P=0.085), stance time (P=0.082), double limb support time (P=0.929) or speed of walking (p=0.325) between the two test conditions. However, using the new powered KAFO improved the SI in step width (P=0.037), swing time (P=0.014), stance phase percentage (P=0.008) and knee flexion during swing phase (p≤0.001) compared to wearing the dropped locked KAFO. Conclusion: The use of a powered KAFO for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage and knee flexion during swing phase

Comparison of the efficacy of a neutral wrist splint and wrist splint with lumbrical unit for the treatment of patients with carpal tunnel syndrome

Purpose: The purpose of this study was to compare the effect of a neutral wrist splint or a wrist splint with an additional metacarpophalangeal (MCP) unit on pain, function, grip and pinch strength in patients with mild-to-moderate carpal tunnel syndrome (CTS). Methods: Twenty four patients received conservative treatment using either the neutral wrist splint or wrist splint with the MCP unit for a period of 6 weeks. Primary outcome measures were pain, function, grip and pinch strength. Data was collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and independent T-test. Results: Compared to baseline, both the neutral wrist splint and the wrist splint with an MCP unit significantly decreased pain, increased function and pinch and grip strength. Comparisons of the two types of splints for grip (P =0.675) and pinch strength (P =0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P =0.022) and the DASH score (P =0.027) between the two types of splints from baseline to 6 weeks. Conclusion: The wrist splint with an MCP unit was more effective than the neutral wrist splint in pain reduction and improvement of function

The Effects of Unloader Knee Orthosis and Lateral Wedge Insole in Patients with Mild and Moderate Knee Osteoarthritis (OA)

Objectives: Patients suffering from mild to moderate knee osteoarthritis may be treated with unloader knee orthoses or laterally wedged insoles. The aim of this study was to identify and compare the effects of two orthoses in these patients. Methods: 56 patients with medial compartment knee OA were evaluated when wearing an unloader knee orthosis and insoles with a 6° lateral wedge which were randomly assigned. Testing was performed at baseline and after 6 months of use with the two types of orthoses. The KOOS score was used to assess outcomes in this study. A paired T test was used for comparing base line and the 6th month post interventions KOOS sub scale score. An independent T test was used for analyzing the efficacy between the two orthoses. Results: Each of the interventions improved all parameters compared to the baseline condition (P=0.000). However, in comparing the effect between these orthoses, we did not find significant differences in activities of daily living (P=0.871), or sports and recreational activities (P=0.351). The pain and symptoms (P=0.000) were, however, significantly different between the two interventions. Discussion: The unloader knee orthoses were more effective than lateral wedge insoles in reducing pain and symptoms

The Immediate Effect of the Toe only Rocker on Walking Parameters in the Patients with Type 2 Diabetes

Introduction: The prevention of foot ulcer and the improvement of gait pattern in the diabetic patients are crucial to understand the lower limbs kinematics. Various kinds of rockers can be used in shoes to reduce the forces applied on the plantar surfaces in patients with diabetic foot. The aim of this study was to investigate the kinematic parameters of gait using toe-only rocker shoes in patients with diabetic foot. Methods and Materials: Forty type 2 diabetic patients (22 females; mean age 58.2) were recruited for participation in this study. Examination of the subject's gait in this study was based on two walking conditions including standard shoes and shoes with toe-only rocker. A three-dimensional gait analyses was conducted to assess the kinematic parameters. For comparison the two test conditions, a paired t-test was utilized. Results: With the application of shoes with toe-only rocker, there was no significant differences in the walking speed improvement compared with standard shoe(P=0.260), However, the step length and cadence (P˂0.001) were significantly increased when walking with toe-only rocker shoe compared with standard shoe. The range of motion of all three lower limb joints (ankle, knee, and hip) was significantly decreased using toe-only rocker shoe (P˂0.05). Conclusion: The present study demonstrated a significant increase in the cadence and step length and a significant reduction in range of motion of lower limb joints during walking using toe-only rocker shoes compared with standard shoes in diabetic patients. Based on the results of this study, it seems that toe-only rocker can improve the gait pattern of people with diabetes. More study with long term follow-up is needed. Keywords: Diabetic Foot, Kinematic, Gait, Toe-only Rocker, Sho

Effect of Prefabricated Insole with Shock Absorb Canal and Custom-Molded Insole on Pain and Function in Subjects with Plantar Fasciitis: A Pilot Study: Effect of insoles on pain and function in plantar fasciitis

Introduction: The purpose of this study was comparison of the effect of custom-molded insole and prefabricated insole with shock absorb canal on pain and function in subjects with plantar fasciitis. Methods and Materials: In this pilot study, fourteen patients with plantar fasciitis were non-randomly assigned to two groups of 7 people. A group received the custom-molded insoles and another group received the prefabricated insoles with shock absorb canal. Before the use of the insoles in each group, the patients ' pain and function were recorded. The pain score was measured by Visual Analog Scale (VAS). For evaluating the function, patients were asked to complete the foot and ankle ability measurement questionnaire (FAAM).Then, patients in both groups used insoles for 6 weeks. After a 6-week use of the insoles, the pain and function were recorded for the second time. Wilcoxon test was used for the effect of insoles in each group (comparison before and after the intervention) and Mann-Whitney test for comparison between two groups. Results: In comparison within each group, the findings showed that the use of both insoles after 6 weeks led to a significant decrease in pain score and a significant increase in the score of daily activities as well as sports activities compared with before use of insoles (P<0.05). There were no statistically significant differences in pain and function scores between the two groups after using the insoles (P>0.05). Conclusion: According to the findings, there was no significant difference between the custom-molded insole and the prefabricated insole in improving pain and function of patients with plantar fasciitis. However, both types of insoles reduced pain and improved the function, with more acceptable to the prefabricated insole

Comparison the Effectiveness of Lateral Wedge Insole with and without Longitudinal Arch Support on Ankles' Function and Pain in People with Medial Knee Osteoarthritis

Introduction: Lateral wedge insole (LWI) is one of the therapeutic interventions in the management of medial compartment knee osteoarthritis. The aim of this study was to investigate the effect of the LWI with and without a medial arch on the pain and the ankle function in patients with medial compartment knee osteoarthritis. Methods and Materials: Twenty-six people with medial knee osteoarthritis were assigned. All participants were asked to complete the questionnaires of the Foot and Ankle Outcome Survey (FAOS) and the Visual Analog Scale (VAS) in the first session. Then, participants were divided into two groups. The first group was given a LWI and the second group a LWI with the medial arch support. After a 6-weeks use of the insoles, participants were asked to complete the questionnaires again. Result: The use of LWI and arch support did not alter all items of the FAOS including the stiffness, pain, activity level, sports restriction, and quality of life restrictions and the VAS score after six weeks compared with the first session (P>0.05), but the using only LWI increased all subscales of FAOS and VAS score after six weeks wearing the insole (P<0.05) and there was no significant change just in the stiffness subscale (P=0.6). Also, the difference between the two groups was significant by increase of all outcomes using only the LWI compared with the LWI along with an arch support (P<0.05). Conclusion: Using a LWI in isolation can result in pain and discomforting in the ankle joint. However, LWI combined with arch support could prevent joint stiffness, pain and discomforting in the ankle joint of patients with medial knee osteoarthritis. Keywords: Ankle; Arch support; Function; Lateral wedge Insole; Medial Knee Osteoarthritis; Pai