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Relief using foot orthoses for osteoarthritis of the knee The perfect choice for patients with bandy legs

Issue 01/2021

A clear result: it is mainly the relief effect that patients benefit from when using a laterally supporting foot orthosis like the TRIactive OA. Prof. Dr. Alexander Mehlhorn is a specialist in orthopedics and trauma surgery. He works as a senior physician at Schön Clinic’s Center for Foot and Ankle Surgery in Munich-Harlaching, Germany. He also evaluated current study data for Bauerfeind.

“Studies show that laterally supporting foot orthoses can relieve the medial knee joint compartment,” Prof. Dr. Alexander Mehlhorn reports.

life: What do international studies say about the benefits of foot orthoses in cases of osteoarthritis of the knee?

Prof. Mehlhorn: For every assertion, we have to bear in mind that there are two versions of this kind of foot orthosis: with a reinforced inner edge for the foot, i.e. in cases of osteoarthritis on the outside, and one with a reinforced outer edge for the foot in cases of osteoarthritis on the inside. The latter is much more common in clinical practice. It’s usually male patients with bandy legs, which are typical for football players, for example. Studies suggest that laterally supporting foot orthosis can relieve the medial knee joint compartment in this group.

How effectively is this research question covered by studies?

Prof. Mehlhorn: There are very many study results for lifting the lateral edge of the foot, but some findings are actually quite varied. For osteoarthritis on the inside, the study data is very good and comprehensive though. The symptoms for osteoarthritis on the outside – which predominantly affects female patients with knock knees – are not as common in medical practice.

Can we predict which patient with osteoarthritis of the knee will benefit from foot orthoses?

Prof. Mehlhorn: No, I haven’t been able to find information about that in the studies. There even seem to be – and I say this with caution – non-responders. I can imagine, for example, someone having quite taut ligaments, which would nullify the effect of the foot orthosis.

Are there any exclusion criteria?

Prof. Mehlhorn: For me, it would be an exclusion criterion if the osteoarthritis is not limited to one knee compartment, meaning not just lateral or medial.

At what point in treatment is the right time for foot orthoses?

Prof. Mehlhorn: In cases of symptomatic (painful) unilateral osteoarthritis of grade 1 or 2, I believe a foot orthosis with lateral or medial support is suitable, but you’d have to wait and see if there is a relevant positive effect.

What do patients suffering from osteoarthritis of the knee expect from treatment with foot orthoses?

Prof. Mehlhorn: Pain reduction is important for patients, of course. But they need to know that there won’t be a functional improvement, and there may not even be a reduction in pain. Patients can, however, stimulate the production of synovial fluid with exercise to protect the cartilage. If pain reduction cannot be achieved, the cause may be another condition, or the osteoarthritis isn’t as unilateral as initially assumed. So sometimes, foot orthoses are used on a trial basis. For the physician, the relief effect is a more important treatment objective. And studies show that a reduction in knee joint adduction can be measured.


Images: Bauerfeind, Conny Kurz

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