Advances in Insoles and Shoes for Knee Osteoarthritis

Rana S Hinman; Kim L Bennell


Curr Opin Rheumatol. 2009;21(2):164-170. 

In This Article


Increased joint loading significantly increases the risk of osteoarthritis progression, but is amenable to change using insoles or footwear. Accordingly, insoles and footwear offer great potential as simple, inexpensive treatment strategies for knee osteoarthritis. On the basis of current research, clinical recommendations for the use of lateral wedge insoles in people with medial knee osteoarthritis include:

  1. Wedge full length of foot not just heel.

  2. Wedge tilt of around 5° as greater tilt (10°) is more likely to be associated with discomfort.

  3. Addition of elastic subtalar strapping or ankle support may improve wedge effectiveness (but may also increase the likelihood of adverse effects and a larger shoe may be required to allow fitting).

  4. Daily usage of 5-10 h may be optimal.

  5. Wedges should be worn in shoes with flat heel and without medial arch supports.

  6. Wedges should immediately reduce pain, if longer term clinical benefits are to be achieved.

  7. Patients who achieve greatest benefits may include those who are younger, are less obese, have less severe disease and have greater lower limb lean muscle mass.

Recent research also allows some recommendations for guiding the clinical use of footwear (Table 1); however, further research is needed to evaluate the efficacy of shoes and shoe modifications in relieving osteoarthritis-associated symptoms and whether biomechanical benefits translate into a reduced risk of disease progression. Research is also required to determine which patient subgroups are most likely to respond to treatment.


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