Journal of Taiwan Occupational Therapy Research and Practice
目的：內側退化性膝關節炎是中老年族群最常見的關節疾患，嚴重地影響日常生活功能。外側楔形鞋墊藉由調整足踝內各肢段空間中之相對位置並改變行走時地面反作用力作用於足部的作用點，縮短地面反作用力與膝關節中心之間的力臂，進而減少患者的膝關節關節力矩、降低關節疼痛。過往探討外側楔形鞋墊療效與助益之回顧文獻的主要限制有二：（一）並未全面納入所有種類鞋墊（二）僅探討外側楔型鞋墊對膝關節之效應。本文將對於1987到2011年之外側楔形鞋墊文獻進行彙整與評析。方法：經由Medline、PubMed與Cochrane Library等資料庫，使用與medial knee osteoarthritis, laterally-wedged insole/orthotics相關之關鍵字進行搜尋，篩選出以探討外側楔型鞋墊之療效與助益為目的之文獻。至2011年7月為止，共有32篇相關文獻納入。結果：全足長外側楔形鞋墊降低膝關節外展力矩的效用顯著優於足跟外側楔形鞋墊。最常與足跟外側楔形鞋墊搭配使用的足部輔具為足踝纏繞彈繃，相較於單獨使用足跟外側楔形鞋墊，足踝纏繞彈繃的搭配使用能夠顯著矯正膝關節靜態站立的內收角度，減輕膝關節僵硬與疼痛程度。相較於單獨使用全足長外側楔形鞋墊，全足長外側楔形鞋墊搭配足弓墊能更顯著降低膝關節外展力矩，並改善踝關節過度外翻所致的不適感。結論：外側楔形鞋墊為一輕度至中度內側退化性膝關節炎患者的保守治療方式。未來應以更為嚴謹之實驗設計驗證其療效與助益，並全面探討其對於功能性活動中步態之影響。
Objective: Medial knee osteoarthritis, being the most common joint disease among the middle-aged adults and the elderly, seriously affects the function of daily living. Laterally-wedged insole may reduce knee joint moments and joint pain with reduced lever arm between ground reaction force and knee joint center through altering the alignment of foot and ankle as well as the contact point of ground reaction force. Previous review articles concerning the effect of laterally-wedged insoles have mainly two limitations: (1) types of insole were not fully included (2) the effects of insoles were discussed only on the knee joint. Thus, the purpose of current review was to synthesize and analyze the studies of laterally-wedged insole from 1987 to 2011. Methods: Medline, PubMed and Cochrane Library were used to identify relevant studies which aimed to investigate the effects and benefits of laterally-wedged insole. Until July, 2011, there were 32 articles included. Results: Full length laterally-wedged insole could significantly reduce knee abductor moment than the heel laterally-wedged insole did. The most common foot assistive device incooperated with laterally-wedged insole was ankle strap. It may enhance the effects of heel laterally-wedged insole by correcting static adducted alignment of knee while standing to reduce joint stiffness and joint pain. Regarding the combined use of arch support, it significantly enhances the effects of full length laterally-wedged insole on reducing knee abductor moment; and it also improved the discomfort resulting from hyper-eversion of ankle joint. Conclusion: Laterally-wedged insole was the conservative therapy for mild and moderate medial knee osteoarthritis. Further research with well-designed experimental methods was suggested to validate the effects and benefits of laterally-wedged insole, and to comprehensively investigate the effect on gait during functional activities.