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Noninvasive Solutions to Knee Pain

Simple Shoe Inserts Make Big Difference

Bottom Line’s Daily Health News—May 19, 2007

My father-in-law suffered with back pain for many years until an orthopedic specialist realized that one leg was slightly longer than the other. By placing a simple orthotic insert into his shoes, the back pain was relieved. It was a simple and elegant solution. Now, this same premise may help sufferers of arthritis in the knee (knee osteoarthritis, or OA). A recently released study investigated if full-length lateral-wedge insoles worn inside shock-absorbing shoes would diminish the joint pain and stiffness while improving knee function of patients with medial compartment (bow legged) knee OA. The conclusion: After four weeks of wearing the insoles, study participants had significantly less pain, less stiffness and better functionality overall.

This study prompted me to call Howard Hillstrom, Ph.D.—who is director of the Leon Root, M.D., Motion Analysis Lab at Hospital for Special Surgery in New York City—to learn more. He tells me there is a growing body of research that shows OA has a biomechanical involvement, meaning the structure of one's body (alignment) is related to the body's function (movement), which may, in some cases, even cause the disease. With medial knee OA (bow legged alignment) there is an increase in pressure to the inner part of the knee called the medial compartment. Similarly, lateral knee OA (knock kneed alignment) will place too much stress on the lateral compartment of the joint. As a result, the cartilage becomes overloaded and degraded, resulting in a knee that is quite sore. With specially designed shoe inserts, the extra weight load can be shifted and balanced over the entire joint, thus reducing pain and preserving what cartilage remains. Dr. Hillstrom adds that there are also specially designed knee braces, lightweight and comfortable, that can be helpful for knee OA as well.

Biomechanical problems are common in people with bow legs, says Dr. Hillstrom. Leg length discrepancy can produce even more subtle biomechanical differences. In a study that involved 3,166 people in North Carolina (6.4% who had a leg length difference), researchers found that a leg length difference increased their risk for OA in both the knees and hips.

One way people notice this is because the legs on their pants hang differently, says Dr. Hillstrom. Knee OA patients may also feel pain while standing, walking or running. It is important to identify a possible body malalignment (bow legged, knock kneed, limb length discrepancy or excessive foot pronation) as early as possible in order to avoid problems down the road, adds Dr. Hillstrom. If you suspect you have such a problem, perhaps because you are experiencing unexplained knee or hip pain, he advises seeing a health-care professional who is trained to detect and treat biomechanically-related problems such as knee OA. These specialists include orthopedists, rheumatologists, physical therapists, podiatrists and orthotists.

Dr. Hillstrom also stresses the importance of proper footwear, especially for people with OA in their knees. Find footwear that is comfortable, naturally, but also look for shoes that come in a variety of widths, to be sure yours fit properly. They should be shaped to the natural contours of your foot and have good cushioning to absorb mechanical shock. He adds that fashion may have to come second, in this case, but the payoff in greater body comfort will be well worth it. A pedorthist can provide excellent advice for footwear needs, says Dr. Hillstrom.

Knee braces, foot orthoses and shoe gear can be "off the shelf" or custom molded. Again, appropriate health-care specialists can help you decide which are appropriate for your condition. Custom-molded technology generally fits better, but costs more.

The full story was originally published on BottomLineSecrets.com.


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