A Comparative Study on the Use of Lateral Heel Wedge and Lateral Wedge Insole in the Treatment of Medial Compartment Osteoarthritis of Knee with Varus Deformity

Abstract

Ab s t r Ac t Background: Osteoarthritis (OA), a degenerative joint disease, has a strong predilection for weight-bearing joints, the most common being the knee. It commonly affects the elderly obese female population. In a world of modern medical marvels, the percentage of elderly population is increasing. The problem of OA especially involving knee joint has become rampant, leading to greater physical, financial, and emotional burden on the patient, family, and society at large. Hence, extensive research has gone into various facets in the treatment of OA, viz., nonpharmacological, pharmacological, and surgical methods, with varying results. This study was concerned with a particular aspect of nonpharmacological therapy, viz., the use of two lateral wedge orthotics, i.e., lateral heel wedge and lateral wedge insole in OA of medial compartment of knee joint with varus deformity. It has been proved through prior research that patients have benefited from each of the above type of lateral wedge orthotics, but there is a paucity of studies that compares them. This study is an attempt toward addressing this gap using various relevant outcome measures. Standard statistical tests were performed and conclusion drawn based on the research findings. Materials and methods: This is a single-blind randomized parallel group trial conducted in the Department of Physical Medicine and Rehabilitation in Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, for a period of 18 months, considering a minimum of 28 subjects in each group. Symptomatic patients having grade II or higher Kellgren–Lawrence radiological grading of tibiofemoral OA along with medial compartment narrowing and varus deformity in standing anteroposterior (AP) view were included. Patients excluded had history of knee trauma or surgery in the past 6 months. Parameters studied were Western Ontario and McMaster (WOMAC) scale, visual analog scale (VAS) score, and 50 ft walk time. Selected patients were divided into two groups randomly and written informed consent was taken from all. One group was given lateral heel wedge of 1/6th inch and the other group was given lateral wedge insole of the same dimension. Selected patients were examined at baseline using the parameters mentioned above and were further examined after intervals of 4 and 8 weeks. The results have been analyzed according to the standard statistical methods to fulfill the aim and objectives of the study. Discussion: Majority of the patients were elderly, overweight females with grade III OA on the Kellgren–Lawrence scale. Outcome measures showed significant difference in both groups, with slightly greater significance in lateral wedge insole group but compliance was higher in lateral heel wedge because of greater comfort level.