Article

OBJECTIVE: To test the hypothesis that a custom-fit valgus knee brace and
custom-made lateral wedge foot orthotic will have greatest effects on decreasing
the external knee adduction moment during gait when used concurrently. DESIGN:
Proof-of-concept, single test session, crossover trial. SETTING: Biomechanics
laboratory within a tertiary care center. PARTICIPANTS: Patients (n=16) with
varus alignment and knee osteoarthritis (OA) primarily affecting the medial
compartment of the tibiofemoral joint (varus gonarthrosis). INTERVENTIONS:
Custom-fit valgus knee brace and custom-made full-length lateral wedge foot
orthotic. Amounts of valgus angulation and wedge height were tailored to each
patient to ensure comfort. MAIN OUTCOME MEASURES: The external knee adduction
moment (% body weight [BW]*height [Ht]), frontal plane lever arm (cm), and ground
reaction force (N/kg), determined from 3-dimensional gait analysis completed
under 4 randomized conditions: (1) control (no knee brace, no foot orthotic), (2)
knee brace, (3) foot orthotic, and (4) knee brace and foot orthotic. RESULTS: The
reduction in knee adduction moment was greatest when concurrently using the knee
brace and foot orthotic (effect sizes ranged from 0.3 to 0.4). The mean decrease
in first peak knee adduction moment compared with control was .36% BW*Ht (95%
confidence interval [CI], -.66 to -.07). This was accompanied by a mean decrease
in frontal plane lever arm of .59cm (95% CI, -.94 to -.25). CONCLUSIONS: These
findings suggest that using a custom-fit knee brace and custom-made foot orthotic
concurrently can produce a greater overall reduction in the knee adduction
moment, through combined effects in decreasing the frontal plane lever arm.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS