“We’re achieving significant results”

In cases of osteoarthritis of the knee, it is worth looking at the whole leg axis, emphasizes Achim Oberle. As a service provider, he relies on a comprehensive care concept with foot orthoses and braces. In cooperation with physicians and physical therapists, knee surgery can usually be delayed by quite a long time.

People not only get older, they also want to stay active for much longer. “These days, even older people still want to go on big trips,” says Achim Oberle, Managing Director at Oberle GmbH & Co.KG in Ettenheim, Baden-Wuerttemberg, Germany. Correspondingly, the number of patients with osteoarthritis of the knee increases continuously.1 “The problem is that there is no cure for this condition. But a lot can be done even without surgery. By supplying suitable medical products in accordance with the guidelines2, pain can be alleviated in most cases and sometimes even entirely eliminated. That keeps patients active and can considerably delay further worsening of the situation,” he says, explaining the experiences he has gained in 15 years of treating osteoarthritis patients. When working with patients, the master orthopedic shoemaker and orthotist pursues a comprehensive approach that takes into consideration the whole leg axis. From the foot position to the position of the knee joint, straightening the axis is designed to guide the forces exerted along the leg to create relief. “We’re achieving significant results with foot orthoses and braces. This has the effect that the need for surgery can delayed for a long time. And that makes patients happy,” says the 52-year-old practitioner – a great starting point for a better quality of life. He also contributed his share to compensating for some of the surgery bottlenecks created by the COVID-19 pandemic. “Medial osteoarthritis of the knee can be treated particularly well. That is because the varus misalignment of the legs, which affects the majority of patients, can be counteracted very efficiently.”’

Consulting, testing, networking

The physician’s diagnosis is always the start of any product supply. “This specifically applies when a customer comes into the store complaining of knee problems, and we can obviously assume it’s due to osteoarthritis, but this hasn’t been confirmed yet,” Achim Oberle explains. “We therefore always recommend a medical appointment and, depending on the stage of the degeneration, discussing braces in addition to foot orthoses as an option so they can be included in treatment considerations.” Over the past few years, Oberle “Gesunde Schuhe”, the store for healthy footwear, has made a name for itself when it comes to products for osteoarthritis of the knee with specialists and family physicians, physical therapists and with patients by way of word-of-mouth. The focus is on comprehensive customer consultation. The Oberle test center is a special highlight. This is where patients can test the practical effect of a brace on their knee and on mobility – an experience that ensures the patient’s compliance with the following therapeutic measure for the prescribing physician. In general, engaging all stakeholders to maximize the treatment outcome is very important to Achim Oberle: “Our motto is networking. With a central onsite contact, we want to reinforce and further develop the interdisciplinary exchange with physicians and physical therapists – for the benefit of the patient,” says Achim Oberle. 

Treatment according to guidelines using foot orthoses and braces

“I want patients to be able to cope with their product. The success of a product depends on how the customer accepts and uses it. Usually, we have to clarify correlations first. In cases of knee pain, a knee brace makes sense to the patient. A foot orthosis that takes effect in the foot area needs more explaining. But if the customer understands the purpose and the mode of action of the product, it will make a huge difference to compliance and therefore treatment success,” Achim Oberle explains. When using medical aids, he focuses on the guidelines issued by the German Society for Orthopedics and Orthopedic Surgery (DGOOC) that consider different products suitable for various stages of osteoarthritis of the knee during non-surgical treatment. While foot orthoses are the product of choice in early stages and in cases of foot misalignments, braces should also be used from a moderate severity onwards to provide relief because the effect a raised outer or inner foot orthosis edge can have on the leg axis is limited. Achim Oberle uses the Bauerfeind solutions specifically developed for the treatment of osteoarthritis of the knee: the new supporting TRIactive OA foot orthosis as well as the relieving GenuTrain OA knee brace. Depending on the heel condition and axial misalignment, they can be worn individually, in succession or combined to form a treatment concept for early muscle strengthening and mobilization.

Get in and feel great

Orthopedic foot orthoses change the position of the feet and joints and therefore have a corrective effect on the whole posture. By raising the outer or inner edge, the medial or lateral part of the knee joint can be relieved. Achim Oberle uses foot orthoses a lot in cases of medial osteoarthritis of the knee: “In general, the outer edge is raised by three to four millimeters as specified by the physician. It’s also important to me to support the central and inner part of the foot at the same time in this case to avoid forcing the patient into a valgus foot position. But the foot orthosis must stay quite slim so it fits the shoes better.” The expert praises the features of the TRIactive OA: “Thanks to its reinforced core and PowerWave technology, i.e. the serration system combining different materials, it’s not only very slim. Most importantly, it ensures guidance of the foot, which is much more important to me in the early stages of osteoarthritis of the knee than cushioning.” He is generally convinced that it is worthwhile to initiate osteoarthritis treatment with foot orthoses. “They are a solution that offers a high degree of wearing comfort. They basically just lie in your shoes, and you’re good to go.” The potential success that can be achieved with foot orthoses in mild cases of osteoarthritis of the knee is crucial for him. “TRIactive OA provides consistency – a foundation from which we can introduce additional measures, if needed.”

An eye-opening treatment experience

If the osteoarthritis of the knee has further progressed, the guidelines recommend the use of a brace. In the test center, the orthotist often watches his patients have an eye-opening experience: when trying out the product, they immediately notice a significant improvement in their knee. Thanks to the mechanical three-point principle, the knee is secured in such a way that the distribution of force provides the medial or lateral knee area with targeted relief. “We get very positive feedback on the adaptable GenuTrain OA in particular. Patients not only feel wrapped up more securely but they also don’t get any pressure points, like with hard frame braces.” The lightweight, elastic knitted fabric is breathable and comfortable to wear. The GenuTrain OA can be subtly worn under clothes and adjusted easily, if needed, through the fabric using the dial. When fitting the brace, Oberle considers the structure of the connective tissue and the patient’s anatomical features, he takes the measurements and instructs the patient not to make the brace too tight initially when trying it on. “We don’t want to overdo it and absolutely want to prevent congestion.” When fitting, the following must always be borne in mind: What can be tolerated? What has the desired effect? What can the patient cope with? “Thanks to its excellent fit, the GenuTrain OA is very easy to put on and position. It has a simple mode of action and is therefore also suitable for older patients. Patients quickly develop trust in their brace. That makes our work enjoyable,” Achim Oberle reports.

The right combination for difficult cases

Depending on the foot misalignment, the guidelines recommend using a combination of foot orthosis and brace from a moderate stage. Together, they reinforce the desired effect: relieving the affected joint area. In combination, the axial correction in the foot area and the guidance of the forces exerted on the knee ensure improved statics along the entire leg. “But you must always make sure that the solution used also fits the patient’s personality,” according to the specialist’s experience. “How likely is it that the patient will actually wear their brace? Might they dislike foot orthoses based on previous experience? These kinds of questions must be considered to find the best possible product. This is the only way we can get the patient to become involved and help them move more easily again.”

Osteoarthritis treatment needs time 

Achim Oberle sees himself and his team as a partner to his customers. That is why the managing director attaches great importance to training to ensure his specialist staff is always up-to-date with the latest innovations. The treatment of patients with osteoarthritis of the knee is not limited to the store counter. Customers always get an individualized appointment for which they must allow at least 20 minutes because in-depth consultation is essential. “You have to develop a pool of experience for that. Continuing training is crucial. But I believe it’s worth it in two ways: on the one hand, it’s the foundation for treating patients more effectively, and on the other hand, you open up a growing market segment.”

Oberle and his team do not want to promise magical solutions but they can optimistically refer to the potential that all those involved can contribute to the treatment process. Continuing follow-up care is an important factor for him. Currently, it takes place after six months when changing the foot orthoses. However, he does usually schedule a first appointment two to four weeks after the product was issued, allowing him to have a better influence during the initial phase in particular. “With the TRIactive OA and the GenuTrain OA, we are well equipped for the treatment of osteoarthritis of the knee. And with the patient’s commitment, we can achieve a lot.”

1 According to the Institute for Quality and Efficiency in Health Care (IQWiG), around four percent of adults in Germany report being medically treated for osteoarthritis of the knee. The number of knee surgeries has been steadily increasing since 2013, and about 194,000 endoprosthetic procedures were recorded across Germany in 2019 (www.iqwig.de/projekte/p20-03.html).
2 The German Association of Orthopedics and Orthopedic Surgery (DGOOC) has created evidence-based guidelines for the treatment of osteoarthritis of the knee. One section is about non-surgical treatment including possible medical aids. Find out more at: https://www.awmf.org/leitlinien/detail/ll/033-004.html

Bilder: Udo Schönewald, Bauerfeind