Authors' objectives: To evaluate whether there is evidence supporting the efficacy or effectiveness of foot orthoses in the clinical management of knee osteoarthritis (OA).

Authors' results and conclusions: A total of 89 citations were identified. There were seven systematic reviews, with or without a meta-analysis, included. Clinical analytical studies on foot orthoses for knee osteoarthritis (OA) are currently scarce. Existing experimental studies largely focus on biomechanics and immediate gait changes in patients with knee OA, are typically conducted in laboratory environments and involve small sample sizes. Generally, these studies are cross-sectional and lack long-term follow-up. Occasional experimental studies with follow-up usually lack a control group and measure pre- and post-orthosis outcomes. These studies cannot ascertain efficacy/effectiveness or optimal usage duration of the foot orthoses. No studies specifically addressing work-related outcomes such as return-to-work (RTW) after foot orthosis application were identified. Studies on disease progress after orthosis application were largely laboratory studies with insufficient follow-up to detect structural changes in knee OA over time. Efficacy and effectiveness of foot orthoses varied across patient groups, with factors such as gender, race (affecting gait and foot anatomy), BMI, and severity of OA influencing outcomes. Some evidence suggests better results in patients with early or mild knee OA. Non-adherence to interventions is a general challenge in OA patients, making long-term studies difficult. Concurrent use of other treatments (e.g., analgesics, NSAIDs) while using foot orthosis may confound study results. Heterogeneity in orthosis type across studies (e.g., insoles laterally or medially wedged, with or without arch support, full or partial length, with or without subtalar strapping, wedge angles 5–10 degrees, heights 7–16 mm) limits generalizable conclusions on efficacy/effectiveness. Baseline medial knee load (measured by knee adduction moment, KAM) may predict future structural sequel in OA; however, most of the time correlations between biomechanical measurements and pain and functional outcomes were inconsistent. Compliance and tolerance outcomes were generally unreported, limiting understanding of adverse effects and cost-effectiveness of foot orthoses. Of seven systematic reviews selected, three were inconclusive regarding efficacy/effectiveness of foot orthoses in managing knee OA. The other three did not support the use of foot orthoses in knee OA, and one reported overall improvement in pain with foot insoles. Overall, the current evidence on foot orthoses for managing knee OA demonstrates modest short-term benefits in biomechanical and pain outcomes. However, these effects are constrained by small sample sizes, absence of control groups, heterogeneity in orthosis types, short follow-up periods, and generally poor methodological quality. No occupational or work related studies were identified on the topic. Long-term studies which assessed the impact of foot orthoses on structural progression of knee OA were also lacking. Consequently, the existing evidence is neither strong nor consistent enough to support the use of foot orthoses in the clinical management of knee OA.

Authors' methods: A comprehensive and systematic literature search was conducted on August 25, 2025. The search was done on commercial medical literature databases where a combination of key words was employed in this search. Except for the ‘year of publication’ (2005-2025) and studies on ‘humans’ no other limits were implemented at this stage. Inclusion and exclusion criteria were predetermined. Manual searches were conducted on the references of relevant articles.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2025

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/osteoarthritis-of-the-knee-foot-orthoses?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23sort%3DDate%26q%3DOsteoarthritis%2520of%2520the%2520Knee%2520and%2520Foot%2520Orthoses%26f%3Alanguage-facet%3D%5BEnglish%5D%26tags%3DHealth%2520Care%2520Provider%7C13468b0b3f074f6bade3f57ac3cdfb8e%2CSystematic%2520Review%7Cf78c29d570c14ec3b5a394385905df70&highlight=Osteoarthritis%20of%20the%20Knee%20and%20Foot%20Orthoses

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

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