The effects of lateral wedge insole on plantar pressure, quadriceps thickness, gait and walking speed for the patients with knee osteoarthritis

[[abstract]]台灣已於2018年進入高齡社會，退化性膝關節炎為影響高齡人口，造成疼痛及失能的主要原因之一，已知退化性膝關節炎患者的行走足底壓力分佈和非患者不同，且股四頭肌肌肉厚度又和關節炎嚴重度相關，本研究探討外側楔形鞋墊對於患者的足底壓力、肌肉厚度、步態及行走速度之影響。 本研究於門診招募退化性膝關節炎患者，隨機分配至外側楔形鞋墊組和一般鞋墊組，於使用鞋墊前和20週後進行測試，受試者接受疼痛視覺類比量尺、WOMAC量表、40公尺快速行走測試、超音波測量股四頭肌肌肉厚度以及行走足底壓力檢測等測試。 共23位受試者完成20週的追蹤，其中外側楔形鞋墊組有13位，一般鞋墊組有10位，結果發現外側楔形鞋墊能有效改善行走速度，減緩股四頭肌肌肉厚度減少，防止行走足底壓力惡化；然可能因外側楔形鞋墊增加足踝外翻角度，造成不適，在疼痛和功能上無顯著改善，或是受到新冠疫情影響，病患外出時間少，影響外側楔形鞋墊效果，則需進一步研究。 本研究從行走速度、股四頭肌肌肉厚度以及行走足底壓力等面向探討外側楔形鞋墊的效果，證實外側楔形鞋墊確有正面影響，如何改善鞋墊設計，積極輔以運動治療，是將來進一步研究的方向。 Taiwan becomes an aged society in 2018. Knee osteoarthritis made elderly people pain and disability. Previous studies proved the knee osteoarthritis patients had different plantar pressure pattern. The quadriceps thickness was related with severity of knee osteoarthritis. The aim of this study was to evaluate the effects of lateral wedge insole on plantar pressure, quadriceps thickness, gait and walking speed for the patients with knee osteoarthritis. The candidate was enrolled at the physical medicine and rehabilitation clinic and allocated to the lateral wedge insole group or ordinary insole group randomized. Tests including pain VAS, WOMAC, 40 meters fast paced walk test, quadriceps thickness measurement with ultrasound and walking plantar pressure test at 0 week and 20 weeks after insole dressing. Twenty-three patients completed 20 weeks follow up, 13 for lateral wedge insole group and 10 for ordinary insole group. The results showed that the lateral wedge insole could improve walking speed, prevent quadriceps thickness decrease and made plantar pressure pattern stabilized. Although there was no significant effect for pain and function with lateral wedge insole. This maybe related with ankle eversion due to wedge insole. And people had less outside activity during COVID-19 may made insole less effective. This study proved the lateral wedge insole having positive effect on walking speed, quadriceps thickness and plantar pressure pattern. Further study for lateral wedge insole with adequate arch support or combined with exercise training was necessary