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Tse, Calvin

University of British Columbia

Introduction: Lateral wedge insoles (LWIs) are a biomechanically-informed intervention designed to reduce magnitudes of the knee adduction moment (KAM), a primary risk factor for medial tibiofemoral osteoarthritis (medial TFOA) progression. Alternative LWIs with arch support and variable-stiffness construction have yet to be investigated comprehensively for their effects on gait biomechanics, internal knee loading characteristics, and implementation for clinical use. This Dissertation investigated the effects of LWIs, and the feasibility of predicting biomechanical responses to LWIs in individuals with medial TFOA. Methods: Three-dimensional gait biomechanics were measured with motion capture technology in healthy adults and those with medial TFOA. All participants completed iterations of walking trials with various LWIs and a flat control insole. Plantar pressure distribution was measured from healthy adults using shoe-embedded pressure sensors (Chapter 4). Tibiofemoral joint contact characteristics during weightbearing with LWIs were assessed by upright magnetic resonance imaging (MRI) in participants with medial TFOA (Chapter 5). Demographic, anthropometric, descriptors of medial TFOA, joint alignment, and movement characteristics of participants with medial TFOA were obtained by clinically-accessible and laboratory-derived methods; these variables were examined for their ability to predict biomechanical responders to LWIs with and without arch support. (Chapter 6). Results: KAM impulse reduction was possible with standalone LWIs and arch-supported LWIs with a variable-stiffness design. Further, ankle eversion from LWIs was mitigated by LWIs with a variable-stiffness arch support. Regional plantar pressure distribution differed between LWIs, such that rearfoot and forefoot pressures were lower with the arch-supported LWIs, while midfoot pressure was lower with the standalone LWIs. MRI demonstrated LWIs can modify tibiofemoral joint contact characteristics during weightbearing, but additional research is necessary to confirm these exploratory findings. Clinically-accessible observations of participant information successfully predicted biomechanical responders to standalone and arch-supported LWIs, with a similar predictive ability as models using laboratory-derived predictors. Conclusion: LWIs are a cost effective and low risk biomechanical intervention for medial TFOA. Nuances between lateral wedge designs may highlight the specific insole that is best suited for different patient presentations. By predicting biomechanical response prior to intervention, improved treatment efficacy with LWIs for managing medial TFOA may be possible.

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2024-06-30

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/81870

Rehabilitation Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/