case_images: PMC10873690_01
case_images: X-ray and MRI images of the patient before intervention.. (A) X-ray: Medial knee OA (K-L grade 3; FTA: 187.5  in the right knee). (B) X-ray: %MA -13.1% in the right knee. (C) MRI: grade 2 BMLs were seen in the proximal medial part of the tibia.. OA, osteoarthritis; MRI, magnetic resonance imaging; BML, bone marrow lesion; MA, mechanical axis; FTA, femorotibial angle; K-L, Kellgren-Lawrence
case_images: cureus-0016-00000052473-i01.jpg
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case_images: FIG1
case_images: Further characterization revealed a femorotibial angle (FTA) of 187.5  and a mechanical axis deviation of -13.1% in the right knee (Figure 1). Before the intervention, the magnetic resonance imaging Osteoarthritis Knee Score (MOAKS) indicated a grade 2 BML in the medial femorotibial joint (Figure 1C).
case_images: Each type of insole was used in this study.. (A) LWI combining arch support and LHW; (B) from left to right: control, placebo, and LWI.. Image credit: So Tanaka.. LWI, lateral wedge insole; LHW, lateral heel wedge
case_images: cureus-0016-00000052473-i02.jpg
case_images: PMC10873690_01_cureus-0016-00000052473-i02.jpg
case_images: FIG2
case_images: We designed an insole that combines an LHW with additional arch support, as studies have reported its greater effectiveness compared to using an LHW alone in reducing varus thrust (Figure 2A). Measurements were conducted under three conditions for a single case: (1) a control insole (insole that came with the shoe), (2) a flat insole of identical thickness to the LWI (placebo), and (3) the LWI itself (Figure 2B). Medial CCRs were 46.7%, 25.7%, and 33.5% in the control, placebo, and LWI groups, respectively (Figure 2D).
case_images: Comparison of anterior acceleration in the varus thrust, CCR, and sacral region under three conditions.. (A) Comparison of TA under three conditions. (B) Comparison of CCR of medial and lateral muscles according to three conditions. (C) Comparison of acceleration in the anterior direction in the sacral region.. LWI, lateral wedge insole
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case_images: PMC10873690_01_cureus-0016-00000052473-i03.jpg
case_images: FIG3
case_images: TA values were 402, 337, and 145 mg for the control, placebo, and LWI groups, respectively, with the lowest value observed in the LWI group (Figure 3A). The lateral CCRs were 48.0%, 44.6%, and 60.8% in the control, placebo, and LWI groups, respectively (Figure 3B). Furthermore, the acceleration in the anterior direction in the sacral region values were 95.2, 153.2, and 171.4 mG for the control, placebo, and LWI groups, respectively, with the highest value observed in the LWI group (Figure 3C).
case_images: Comparison of BML size MRI before and after intervention.. Change in BMLs. The BMLs, which were initially graded 2 (A), were reduced to grade 1 after 12 months (B).. BML, bone marrow lesion; MRI, magnetic resonance imaging
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case_images: PMC10873690_01_cureus-0016-00000052473-i04.jpg
case_images: FIG4
case_images: FTA of 187.6 . Furthermore, BML in the medial femorotibial joint reduced from grade 2 at baseline to grade 1 at 12 months (Figure 4).
case_images: Results of varus thrust, CCR before and after intervention, and anterior acceleration of the sacral region.. (A) TA was 332 mG at 12 months compared to 402 mG at baseline. (B) The initial medial CCR was 46.7%, decreasing to 26.2% at 12 months, while the initial lateral CCR was 48.0%, decreasing to 36.0% at 12 months. (C) The anterior acceleration of the sacral region increased from 95.2 mG at baseline to 360.2 mG at 12 months.
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case_images: PMC10873690_01_cureus-0016-00000052473-i05.jpg
case_images: FIG5
case_images: The results revealed a reduction in TA from 402 mG at baseline to 332 mG at 12 months (Figure 5A). Initial medial CCRs decreased from 46.7% to 26.2%, and lateral CCRs decreased from 48% to 36% at 12 months (Figure 5B). In addition, the anterior acceleration of the sacral region increased from 95.2 mG at baseline to 360.2 mG at 12 months (Figure 5C).