| Summary: | 碩士 === 中國醫藥大學 === 醫學研究所碩士班 === 94 === Objective： The knee joints are most frequently involved degenerative arthritis for the patients in the older society. The patients with knee osteoarthritis (OA) may have the following complaints： knee joint pain, stiffness of the knee joint, limited range of motion (ROM), wasting of the lower limb muscle, and decreased walking speed. These symptoms can decrease the performance of some activities of daily life obviously and followed a potential dangerousness. This research attempts to explain the changes of the kinetics and kinematics of the lower limbs while knee OA patients performing level walking. Lateral-wedge insole has been used to treat knee OA, but the biomechanical nature has not been well studied, and its side effect is unclear. In this study, the influence and the side-effect of the lateral-wedge insole will be investigated. Finally, we expected to apply the insole clinically to slow the degenerative process of the knee joint, to maintain life quality of the elder, and to reduce the medical costs （medicine, physical therapy, and surgery）.
Methods： Twelve outpatients (eight female and four male, mean age, 70.7; standard deviation, 5.9) with knee OA involving the medial compartment were prospectively treated with an inserted wedged insole with lateral elevation of 12 mm for twelve weeks. The visual analog scale (VAS) scores for subjective knee pain and the remission score of the Lequesne index of severity for knee OA were assessed before and 3-months after treatment. Standing radiographs with and without insoles were used to analyze the femorotibial, talocalcaneal and talar tilt angles at baseline, immediate and final assessment. Three-dimensional motion analysis system and force platform were used to calculate kinematic and kinetic gait parameters in level walking, including spatiotemporal parameters, range of motion (in lower limbs, trunk and head), forces and moments in hip, knee and ankle joints and sway range of the center of gravity. Difference in all parameters between baseline assessments and immediate or final assessments were compared using a paired t test.
Results： The 12 patients who completed the 12-weeks study were evaluated. Participants wearing the inserted lateral wedged insole had significantly improved VAS pain score and remission score of the Lequesne index (P<0.0001). No significant differences were found in femorotibial, talocalcaneal and talar tilt angles while comparison among values at baseline, immediate and 3-months after treatment. Patients using a lateral wedged insole had an immediate and significant increase in step width, heel maximum height, and swing phase time, but reduced stance phase of the gait cycle as compared with the baseline data. Beside, increased ROM in ankle inversion-eversion and decreased ankle plantar-dorsiflexion ROM were found. They also generated more ankle invertor moment, internal rotator moment, knee extensor moment, and less ankle plantar flexor moment, ankle evertor moment and hip flexor and abductor moment.
Conclusion： The inserted lateral wedged insole may induce symptomatic relief in patients with medial compartment knee OA, but not make any significant changes in the radiographs taken in the static position. The therapeutic effects were further evaluated during the dynamic phase with motion analysis system and force plates to determine the kinematic & kinetic effects. Longer-term clinical follow up should be addressed in future studies.
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