Lateral Wedge Insoles in Knee Osteoarthritis: A Post-EULAR 2023 Review of Biomechanical and Clinical Outcomes

Abstract

Knee osteoarthritis is a chronic condition leading to pain, functional limitations, and structural joint changes. Non-surgical management includes patient education, exercise therapy, and weight reduction. The use of lateral wedge insoles (LWIs) remains controversial, and current evidence regarding their effectiveness is inconclusive. This review aimed to examine recent studies published after the 2023 European Alliance of Associations for Rheumatology (EULAR) guidelines on the use of LWIs in the management of knee osteoarthritis (KOA), with particular emphasis on their effects on joint biomechanics and clinical outcomes. A targeted search was conducted in PubMed for publications from May 2022 to 2025 related to KOA and LWIs. Nine studies were included in the analysis: five randomized controlled trials, one network meta-analysis, two experimental studies, and one non-randomized clinical-control study. Biomechanical outcomes (knee adduction moment, tibial rotation, center of pressure displacement) and clinical outcomes (pain and joint function) were evaluated. Some studies reported beneficial effects of LWIs on biomechanical parameters and subjective pain perception, including improved gait comfort, reduced lateral knee displacement, and decreased pain. Other studies found no significant clinical effects, and observed biomechanical changes did not consistently translate into functional improvements. Variability in outcomes may reflect differences in individual biomechanics, severity of joint degeneration, duration of insole use, and the design of the intervention. LWIs may improve selected biomechanical parameters of the knee joint, but their clinical efficacy remains uncertain. They should not be used as a standalone treatment. Further research is needed to identify predictors of therapeutic response.