The latest estimates from 2018 show that approximately 2.2 million Australians, or just under 10% of us, currently have osteoarthritis. It’s no small or insignificant matter, with a 38% skyrocket in the number of total knee replacements as a direct result of osteoarthritis over the decade prior.
Unlike other pains or injuries we treat, the effects on a joint from osteoarthritis are irreversible – and not to mention detrimental to a person’s health and well-being, with people with osteoarthritis being twice as likely to describe their health as ‘poor’ among those aged over 45 years.
With a complex and debilitating condition comes the need for effective and evidence-based management. We tactfully say management in place of ‘treatment’ because while we can’t reverse your osteoarthritis, we can help improve your comfort, reduce your pain, and keep you mobile, independent, and doing the things you love for as long as possible.
While we have other management options for osteoarthritic pain available in the clinic including laser pain relief and ANF therapy, today we thought we’d share with you the current evidence behind the use of orthotics in managing osteoarthritic pain and discomfort on the inside of the knee, known as medial knee osteoarthritis.
To best understand how orthotics can help with osteoarthritis (OA) on the inside of the knee, let’s have a quick review of what is happening when you have OA in this area.
Firstly, the inside of the knee joint (we call this the ‘medial’ knee) is already the most common site for knee OA. Thinking back to the wear and tear mechanism of OA, more stress, pressure and compression forces on this area, which often arises from the way we use and overuse our knee joint during life, means that damage to the cartilage on the inside of the knee occurs faster. As this cartilage is crucial in helping keep the joint gliding smoothly and absorbing potentially damaging forces, the inside of the knee joint deteriorates, the gap between the bones thins, and moving the knee – particularly bending movements – can quickly become painful and uncomfortable.
Where orthotics come into the equation is in their ability to, when prescribed correctly, to shift further forces and pressure away from the inside of the knee, and help open the joint space on the inside of the knee further so there is less rubbing and friction during movement.
It goes without saying that we are not talking about using your one-size-fits-all pharmacy-style orthotics that have zero consideration for your pains or unique foot and leg characteristics. What we are talking about are custom-prescribed foot orthotics, where every characteristic is detailed by your podiatrist following a comprehensive foot and leg assessment, paired with a video gait analysis. If you’re unfamiliar with orthotics, we’ve shared more about them here.
As board-registered health professionals that are founded on evidence-based treatment, it’s important for us to consider all the evidence, alongside the positive results that our patients are experiencing.
Looking at a specific style of orthotics that applies wedging to the outside of the heel, numerous studies have confirmed that these orthotics are able to achieve shifts in both knee movement and knee mechanics that offload the medial knee, and therefore reduce the painful symptoms associated with OA.
As practitioners that firmly believe in looking at both sides of the coin and giving our patients all the information so they can make fully informed decisions, we will point out a few things:
The ability of orthotics to effectively achieve this function is influenced by the skill of the prescribing podiatrist. As a prescription device, much like glasses, they need to be designed and made correctly. So it is crucial that your podiatry team has extensive experience with orthotic prescription – including for this specific condition. Otherwise, your outcomes may not be as effective as they otherwise could be – or not effective at all.
Some studies have shown little results from this method. Studies have been conducted previously that have concluded that orthotics with this wedging did not produce better results than orthotics with neutral wedging for knee osteoarthritis. These studies actually concluded that this prescription should be given on a case-by-case basis due to other in-clinic experience of this technique working. Our view on this is that the orthotics they used are different to the ones we use – and that their design and prescription process was different, and more of a one-size-fits-all option, which is never practical in healthcare. What you should take away from this is that there’s no guarantee that it will work – not even from us – due to the unique nature of every foot, and the variances in severity and the degeneration process of OA in every person.
We’re talking about an improvement in symptoms, not complete pain relief. When we talk about these studies and the results, they are measuring against a ‘significant’ improvement in pain – and so are we. For someone that is in constant severe pain, a relief of even 20% or 30% can really improve their lives. A significant improvement to your symptoms and your quality of life is what we aim for here – as opposed to complete pain relief, which is highly unlikely due to the degenerative nature of the disease and the irreversible damage.
Honestly? There’s only one way to find out. We are getting positive results with many patients in our clinic, but it’s important for you to consider all of your treatment options based on your unique symptoms and level of joint damage. What we love about orthotics is that they’re non-invasive – there’s no surgery, anaesthetic or long recovery times. This makes your risks of this technique fairly minimal – though still possible when you consider we are changing the way your lower legs are functioning biomechanically.
Unlike surgery or other invasive methods, however, you can take your orthotics off at any time. If you’d like to learn more about if this could be right for you, or learn about the other therapies we offer for osteoarthritic pain, call us on 1300-FX-FEET.