Walking

Walking is a good and accessible way to get moving (again), but for patients with osteoarthritis of the knee, hip or ankle/foot, walking can sometimes be difficult and result in pain. Braces, arch supports or other walking aids may offer a solution.

Use of a brace

In osteoarthritis, changes in position often occur in a joint. This can lead to an increase in complaints and aggravate the osteoarthritis. In the case of a position deviation, a brace can provide relief and reduce the complaints in the longer term. Examples of joints where a brace can provide relief are; the ankle, the knee, the hand and wrist or the elbow. For example, a knee brace can prevent the knee from bending inwards too much during walking, which causes an unfavorable load on the joint (Sharma et al 1998). There are two types of braces that are commonly used for knee osteoarthritis: a valgus knee brace for osteoarthritis on the inside of the knee and a patellar brace for wear and tear on the back of the kneecap. Most studies show a positive effect on pain and physical function wearing a brace compared to not wearing a brace. Both the valgus brace and the patella brace hardly give any side effects. A disadvantage is that within a year almost half of the patients stop wearing a knee brace due to little effect. The treatment is more effective in patients with severe osteoarthritis than in patients with mild or moderate osteoarthritis.

Patellar brace

A patellar brace is a brace that moves the kneecap inwards, reducing the pressure between the kneecap and the upper leg bone. In addition, the brace increases the feeling of stability. A patellar brace is mainly prescribed for patients with serious complaints in whom the cartilage at the back of the kneecap has worn out and for whom other conservative measures are insufficiently effective.

Most studies of a patellar brace for patellofemoral osteoarthritis show a beneficial effect on osteoarthritis symptoms.

Valgus brace

In most people with moderate to severe osteoarthritis of the knee, the inner part of the knee is affected. The cartilage on the inside of the knee wears away, causing a bow-leg position. A valgus knee brace ensures that the bow-leg position is reduced, so that the outer part of the knee is subjected to more load and the inner side of the right leg is relieved. A valgus knee brace should be prescribed by an orthopedic surgeon, rehabilitation physician, sports doctor or sports physician. The purpose of a valgus knee brace is to reduce the symptoms and to postpone joint replacement surgery as long as possible, especially in relatively young and active patients.

Gait analysis and arch supports

Most studies show little added value of arch supports for osteoarthritis complaints. Most guidelines therefore advise not to use insoles for the treatment of osteoarthritis. Yet there are also studies that show that an arch support can help reduce pain and stiffness and improve the function of a joint. Because little research has been done into the effect of arch supports and because these studies differ greatly, no definitive conclusions can be drawn about these walking aids (Kan 2019, Raja 2011).

A study by Starkey (2022) shows that sturdy shoes that provide good support can reduce the forces acting on the inside of the knee and may be useful for people with wear and tear on the inside of the knee.

Gait retraining

In recent years, much attention has been paid to ‘Gait retraining‘ to reduce complaints during walking. The walking technique is mapped out by means of a gait analysis, after which targeted training takes place to adjust the walking technique so that the joint is more favorably loaded. Gait retraining ensures that the knee bends inwards less. This research is still in its infancy, but there are indications that changes in stride length, foot position and body center of gravity can positively influence the forces acting on the knee (Huang 2022, Silva 2023).