Mary Ann Forciea MD September 22 2016 Source Hinman RS et al Unloading Shoes for Selfmanagement of Knee Osteoarthritis Ann Int Med 2016 165381 Editorial P 443 Background OA of knee common self management often recommended ID: 734443
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Slide1
Cinderella and arthritic knees
Mary Ann Forciea MD
September 22 2016Slide2
Source
Hinman
, RS et al. Unloading Shoes for Self-management of Knee Osteoarthritis. Ann
Int
Med 2016. 165:381
Editorial: P 443Slide3
Background
OA of knee common, self management often recommended
Weight loss, exercise, FOOTWEAR
Medial compartment loading greater, damage greater
Unloading shoes: soles stiffer laterally than medially reduce medial knee loads
Now available commerciallySlide4Slide5
hypothesis
Unloading shoes will
Reduce pain
Improve physical function
At 6 months
Compared to
convential
‘walking shoes’Slide6
method
2 group, parallel group, comparative effectiveness RCT
Melbourne, 2013-2015
Eligible:
>50
yrs
knee pain on most days of prior month
average pain of 4 on 11 point scale in prior week
XR evidence of OK and medial compartment greater disease than lateralSlide7
Method 2
Exclude:
Lateral disease >medial
IA steroids or surgery in prior 3 months
Prior TKR or planned in 3 months
Systemic rheumatic illness
Other condition limiting lower leg use
Prior 6 month use of shoe inserts
Inability to walk unassisted
BMI >36
-pain in ankle or footSlide8
Method 3
Randomized in blocks by radiographic severity
Shoes identical; everyone blind
Wear >4hr/day every day for 6 months
Log of hours – 7 consecutive days/month
Shoe mounted pedometer for step count
7 days in 4
th
week of months 2 and 5Slide9
Outcomes
Self reported pain scales 3
mo
, 6
mo
NRS (clinically
impt
1.8 points)
WOMAC function (MCID 6)
WOMAC pain (MCID) >18%
Harms – pain >2 days or required medsSlide10
Results
Matching good (Table 1) (slightly young for us)
Primary (Table 2): both groups improved in primary, no meaningful difference @3
mo
Did wear shoes(7 hrs), little drop out(2%), incorrect guessing
At 6
mo
, improved function with unloading shoes, not pain
Secondary no differences Slide11
Conclusions (authors)
No difference in shoe group for pain and function
Both types did improved function, unloading shoes better for pain
“Knee osteoarthritis symptoms may not be as strongly influenced by abnormal biomechanics as the literature suggests”
Of course subgroups might existSlide12
Conclusions Mine
Both groups improved
Surprising number of steps/day for patients with OA
I am unconvinced of clinical differences in any outcome.
What is the influence of ‘special shoes’ whether walking shoes or unloading shoes?
Isn’t it the WALKING
that helps?