Braces & Wedges

Prescription Analgesics Steroid Injection


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What is it and why?

  • Knee braces or appropriately placed heel wedges can help redistribute the load and avoid too much force going through the affected joint.

  • This method is only appropriate for a selected few patients who have a certain type of asymmetrical joint wear.

  • A physiotherapist will decide whether these are appropriate for you after a detailed assessment.


  • Treatment does not involve Home/self-help
    Home/self-help
  • Treatment involves Hospital
    Hospital
  • Treatment involves Daycase procedure
    Daycase procedure
  • Treatment does not involve Inpatient procedure
    Inpatient procedure
  • Treatment does not involve Local anaesthetic
    Local anaesthetic
  • Treatment does not involve General anaesthetic
    General anaesthetic
  • Treatment does not involve Regional block / Spina
    Regional block / Spina
  • Pain
    Pain

    Minor

  • Mobility
    Mobility

    May affect balance

  • Daily activities
    Daily activities

    Minor

  • Driving
    Driving

    Minor

  • Leisure activities
    Leisure activities

    No more than usual

  • Light exercise
    Light exercise

    Minor

  • Heavy exercise
    Heavy exercise

    Minor

  • Light work
    Light work

    Minor

  • Heavy work
    Heavy work

    Minor

  • Intimate
    Intimate

    Minor


Overview

What does it involve?

  • Heel wedges - By placing a wedge in the sole of the footwear, at the level of the heel, the forces in the knee are redistributed correctly.

  • For example, the wedge commonly used to treat bow-legs (a knee which curves outward from the middle) is higher on the outer side.

  • Braces - These achieve a similar effect to heel wedges by placing appropriate straps which, when tightened, will help the forces in the joint to be evenly distributed.

Effort/burden

  • These items are prescribed by a physiotherapist after a full clinical assessment.

  • You may have to swap the heel cushion to different footwear, and it may not work in all footwear.

  • Applying the brace can be cumbersome and may limit the type of clothes you can wear.

  • These aids need to be worn regularly to gain full benefit.

Benefits

  • There is fair to good evidence for the use of heel wedges (bowleg) for various knees and knee braces for specific types of asymmetric joint wear (unicompartmental arthritis).

  • Moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the short term.

  • Potential to slow down the speed of deterioration and joint wear.

Chances of cure

  • These measures are unlikely to cure arthritis on their own.

  • However, they can improve the symptoms of arthritis, activities of daily living (ADL) and mobility.

Limitations and side effects

  • In the initial stages of using heel wedges, patients may find that their balance is affected.

  • These interventions are not applicable to all types of asymmetric wear of the joint and therefore only a few patients will benefit from this.

Risks

  • No major risks identified with the use of these physical aids.

  • Avoid over-tightening of the brace to prevent pressure effects to the skin.

Cost

  • Low cost option for the patient and a variable cost for the NHS.

  • NHS: Generally not an expensive option, but braces tend to be single-use and may need replacing.

What if no treatment is done?

  • Arthritis will continue to deteriorate.

  • Symptoms will get worse; sometimes rapidly.

  • Will have a negative influence on other management options, e.g. surgery, in the future.


Prescription Analgesics Steroid Injection