Braces & Wedges
Prescription Analgesics Steroid Injection
What is it and why?
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Knee braces or appropriately placed heel wedges can help redistribute the load and avoid too much force going through the affected joint.
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This method is only appropriate for a selected few patients who have a certain type of asymmetrical joint wear.
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A physiotherapist will decide whether these are appropriate for you after a detailed assessment.
- Applicable stages 3 & 4
- Best stages 3 & 4
- Cost Very low cost
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Home/self-help
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Hospital
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Daycase procedure
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Inpatient procedure
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Local anaesthetic
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General anaesthetic
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Regional block / Spina
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Pain
Minor
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Mobility
May affect balance
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Daily activities
Minor
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Driving
Minor
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Leisure activities
No more than usual
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Light exercise
Minor
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Heavy exercise
Minor
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Light work
Minor
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Heavy work
Minor
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Intimate
Minor
Overview
What does it involve?
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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.
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For example, the wedge commonly used to treat bow-legs (a knee which curves outward from the middle) is higher on the outer side.
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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
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These items are prescribed by a physiotherapist after a full clinical assessment.
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You may have to swap the heel cushion to different footwear, and it may not work in all footwear.
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Applying the brace can be cumbersome and may limit the type of clothes you can wear.
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These aids need to be worn regularly to gain full benefit.
Benefits
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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).
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Moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the short term.
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Potential to slow down the speed of deterioration and joint wear.
Chances of cure
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These measures are unlikely to cure arthritis on their own.
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However, they can improve the symptoms of arthritis, activities of daily living (ADL) and mobility.
Limitations and side effects
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In the initial stages of using heel wedges, patients may find that their balance is affected.
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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
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No major risks identified with the use of these physical aids.
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Avoid over-tightening of the brace to prevent pressure effects to the skin.
Cost
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Low cost option for the patient and a variable cost for the NHS.
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NHS: Generally not an expensive option, but braces tend to be single-use and may need replacing.
What if no treatment is done?
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Arthritis will continue to deteriorate.
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Symptoms will get worse; sometimes rapidly.
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Will have a negative influence on other management options, e.g. surgery, in the future.
Videos

What is a knee brace
References
https://bmjopensem.bmj.com/content/2/1/e000195 (unloading knee brace)
https://www.ncbi.nlm.nih.gov/pubmed/29543576 (Valgus off-loading brace)