Effects of medial and lateral wedged orthoses on knee and ankle joint loading in female runners

  • Jonathan Sinclair Faculty of Health & Wellbeing, University of Central Lancashire http://orcid.org/0000-0002-2231-3732
  • Philip Stainton Faculty of Health & Wellbeing, University of Central Lancashire


The aim of the current investigation was to examine the effects of orthoses with a 5° medial and lateral wedge on knee and ankle joint kinetics in female runners. Twelve healthy female runners ran at 3.5m/s over a force platform in three conditions (medial, lateral and no-orthotic). Lower extremity kinematics were measured using an 8 camera motion capture system which allowed knee and ankle loading to be explored using a musculoskeletal modelling approach. Peak Achilles tendon force was significantly larger in the no-orthotic condition (5.34 BW) compared to the lateral orthosis (5.03 BW). Peak patellofemoral force was significantly larger in the medial orthosis (2.77 BW) compared to the lateral (2.62 BW) and no-orthotic (2.60 BW) conditions. Finally, peak knee adduction moment was significantly larger in the medial condition (1.14 Nm/kg) compared to the lateral (0.99 Nm/kg) orthosis. The findings from the current investigation indicate that lateral orthoses may be effective in attenuating risk from medial tibiofemoral osteoarthritis and Achilles tendinopathy, but medial wedge orthoses may increase the risk from patellofemoral pain in female runners.

Author Biography

Philip Stainton, Faculty of Health & Wellbeing, University of Central Lancashire
Research Assistant


Baker, K., Goggins, J., Xie, H., Szumowski, K., LaValley, M., Hunter, D. J., & Felson, D. T. (2007). A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis & Rheumatology. 56, 1198-1203.

Barrios, J. A., & Davis, I. S. (2010). The influence of lateral wedging over time in patients with medial knee osteoarthritis: an analysis of frontal plane knee mechanics and clinical outcomes. Journal of Orthopaedic & Sports Physical therapy. 40, 25-26.

Barrios, J. A., Butler, R. J., Crenshaw, J. R., Royer, T. D., & Davis, I. S. (2013). Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after 1 year of wear. Journal of Orthopaedic Research. 31, 659-664.

Bennell, K. L., Bowles, K. A., Payne, C., Cicuttini, F. M., Williamson, E., Forbes, A., & Hinman, R. S. (2010). Effects of lateral wedge insoles on symptoms and structural disease progression in medial knee osteoarthritis: a 12-month randomised controlled trial. Osteoarthritis & Cartilage. 18, 11-12.

Besier, T.F., Draper, C.E., Gold, G.E., Beaupre, G.S., Delp, S.L. (2005). Patellofemoral joint contact area increases with knee flexion and weight-bearing. Journal of Orthopaedic Research. 23, 345–350.

Birmingham, T.B., Hunt, M.A., Jones, I.C., Jenkyn, T.R., and Giffin, J.R. (2007). Test–retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis. Arthritis Care Research. 57, 1012-1017.

Bonanno, D. R., Landorf, K. B., Munteanu, S. E., Murley, G. S., & Menz, H. B. (2017). Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis. British Journal of Sports Medicine. 51, 86-96.

Cappozzo, A., Catani, F., Leardini, A., Benedeti, M.G., & Della, C.U. (1995). Position and orientation in space of bones during movement: Anatomical frame definition and determination. Clinical Biomechanics. 10, 171-178.

Collins, N.J., Bierma-Zeinstra, S.M., Crossley, K.M., van Linschoten, R.L., Vicenzino, B., & van Middelkoop, M. (2012). Prognostic factors for patellofemoral pain: a multicentre observational analysis. British Journal of Sports Medicine. 47, 227-233.

Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine. 43, 409-416.

Crossley, K. M. (2014). Is patellofemoral osteoarthritis a common sequela of patellofemoral pain?. British Journal of Sports Medicine. 48, 409-410.

Crossley, K.M., Stefanik, J.J., Selfe, J., Collins, N.J., Davis, I.S., Powers, C.M., McConnell, J., Vicenzino, B., Bazett-Jones, B.M., Esculier, J-F, Morrissey, D., Callaghan, M.J. (2016). Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. British Journal of Sports Medicine. 50, 839–843.

Greenhalgh, G., & Sinclair, J. (2014). Comparison of Achilles tendon loading between male and female recreational runners. Journal of Human Kinetics. 44, 155-159.

Graydon, R., Fewtrell, D., Atkins, S., Sinclair, J. (2015). The test-retest reliability of different ankle joint center location techniques. Foot & Ankle Online Journal. 8, 1-11.

Hinman, R. S., Bowles, K. A., Payne, C., & Bennell, K. L. (2008). Effect of length on laterally‐wedged insoles in knee osteoarthritis. Arthritis Care Research. 59, 144-147.

Hinman, R. S., Bowles, K. A., & Bennell, K. L. (2009). Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear?. BMC Musculoskeletal Disorders. 10, 146-151.

Ho, K.Y., Blanchette, M.G., & Powers, C.M. (2012). The influence of heel height on patellofemoral joint kinetics during walking. Gait & Posture. 36, 271-275.

Hreljac, A. (2004). Impact and overuse injuries in runners. Medicine & Science in Sports & Exercise. 36, 845-849.

Janakiraman, K., Shenoy, S., & Sandhu, J. S. (2011). Firm insoles effectively reduce hemolysis in runners during long distance running-a comparative study. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 3, 12-16.

Jones, R. K., Zhang, M., Laxton, P., Findlow, A. H., & Liu, A. (2013). The biomechanical effects of a new design of lateral wedge insole on the knee and ankle during walking. Human Movement Science. 32, 596-604.

Kean, C. O., Hinman, R. S., Bowles, K. A., Cicuttini, F., Davies-Tuck, M., & Bennell, K. L. (2012). Comparison of peak knee adduction moment and knee adduction moment impulse in distinguishing between severities of knee osteoarthritis. Clinical Biomechanics. 27, 520-523.

Liu, X., & Zhang, M. (2013). Redistribution of knee stress using laterally wedged insole intervention: finite element analysis of knee–ankle–foot complex. Clinical Biomechanics. 28, 61-67.

Miyazaki, T., Wada, M., Kawahara, H., Sato, M., Baba, H., & Shimada, S. (2002). Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Annals of the Rheumatic Diseases. 61, 617–622.

Pham, T., Maillefert, J. F., Hudry, C., Kieffert, P., Bourgeois, P., Lechevalier, D., & Dougados, M. (2004). Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a two-year prospective randomized controlled study. Osteoarthritis & Cartilage. 12, 46-55.

Powers, C.M., Lilley, J.C., & Lee, T.Q. (1998). The effects of axial and multiplane loading of the extensor mechanism on the patellofemoral joint. Clinical Biomechanics. 13, 616–624.

Rafiaee, M., & Karimi, M.T. (2012). The effects of various kinds of lateral wedge insoles on performance of individuals with knee joint osteoarthritis. International Journal of Preventative Medicine. 3, 693-698.

Rubin, R., & Menz, H. B. (2005). Use of laterally wedged custom foot orthoses to reduce pain associated with medial knee osteoarthritis: a preliminary investigation. Journal of the American Podiatric Medical Association. 95, 347-352.

Self, B. P., & Paine, D. (2001). Ankle biomechanics during four landing techniques. Medicine & Science in Sports & Exercise. 33, 1338-1344.

Selvanetti, A., Cipolla, M., & Puddu, G. (1997). Overuse tendon injuries: basic science and classification. Operative Techniques in Sports Medicine. 5, 110-117.

Shimada, S., Kobayashi, S., Wada, M., Uchida, K., Sasaki, S., Kawahara, H., & Baba, H. (2006). Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis. Archives of Physical Medicine & Rehabilitation. 87, 1436-1441.

Sinclair, J. (2014). Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running. Clinical biomechanics. 29, 395-399.

Sinclair, J., Isherwood, J., & Taylor, P. J. (2014). Effects of foot orthoses on Achilles tendon load in recreational runners. Clinical biomechanics. 29, 956-958.

Sinclair, J., Taylor, P.J., Currigan, G., Hobbs, S.J. (2014). The test-retest reliability of three different hip joint centre location techniques. Movemant & Sport Sciences. 83, 31-39.

Sinclair, J., Hebron, J., Taylor, P.J. (2015). The Test-retest Reliability of Knee Joint Center Location Techniques. Journal of Applied Biomechanics. 31, 117-121.

Sinclair, J., & Selfe, J. (2015). Sex differences in knee loading in recreational runners. Journal of Biomechanics. 48, 2171–2175.

Sinclair, J., Vincent, H., Selfe, J., Atkins, S., Taylor, P. J., & Richards, J. (2015). Effects of foot orthoses on patellofemoral load in recreational runners. Foot & Ankle Online Journal. 8, 5-12.

Sinclair, J., Richards, J., Selfe, J., Fau-Goodwin, J., & Shore, H. (2016). The influence of minimalist and maximalist footwear on patellofemoral kinetics during running. Journal of Applied Biomechanics. 32, 359-364.

Taunton, J.E., Ryan, M.B., Clement, D.B., McKenzie, D.C., Lloyd-Smith, D.R., and Zumbo, B.D. A retrospective case-control analysis of 2002 running injuries. (2002). British Journal of Sports Medicine. 36, 95-101.

van Eijden, T.M., Kouwenhoven, E., Verburg, J., and Weijs, W.A. A mathematical model of the patellofemoral joint. (1998) Journal of Biomechanics. 19, 219–229.

van Gent, B.R., Siem, D.D., van Middelkoop, M., van Os, T.A., Bierma-Zeinstra, S.S., Koes, B.B. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British Journal of Sports Medicine. 41, 469-480.

Van Ginckel, A., Thijs, Y., Hesar, N. G. Z., Mahieu, N., De Clercq, D., Roosen, P., & Witvrouw, E. (2008). Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study. Gait Posture. 29, 387-391.

Ward, S.R., & Powers, C.M. (2014). The influence of patella alta on patellofemoral joint stress during normal and fast walking. Clinical Biomechanics. 19, 1040–1047.

Wise, B.L., Niu, J., Yang, M., Lane, N.E., Harvey, W., Felson, D. T., & Lewis, C.E. (2012). Patterns of compartment involvement in tibiofemoral osteoarthritis in men and women and in whites and African Americans. Arthritis Care Research. 6, 847-852.