engleski

Remote production of foot orthotics for the treatment of the knee osteoarthritis

Very common degenerative joint disease is the one that affects knee and we usually address it as knee osteoarthritis. Although the causes of knee osteoarthritis are not completely understood, biomechanical stresses affecting the articular cartilage and subchondral bone, biochemical changes in the articular cartilage and synovial membrane, genetic factors, and nutritional factors are all important in its pathogenesis. Patients with knee osteoarthritis have pain that typically worsens with weight bearing and activity and improves with rest, as well as morning stiffness and gelling of the involved joint after periods of inactivity. On physical examination, they often have tenderness on palpation, bony enlargement, crepitus on motion, and/or limitation of joint motion. Patients often have difficulty walking and reduction of daily activities and subsequent depression. The recommended approach (American College of Rheumatology) to the medical management of knee osteoarthritis includes first nonpharmacologic modalities and drug therapy, and at the end surgical treatment. There are several agents and therapeutic approaches under investigation, and foot orthotics. In knee osteoarthritis mostly affected is medial compartment of the knee, which is even in health individuals 60-70% weight bearing during walk. With developing of the disease, increased pressure in that region will be mostly the cause of the pain. Lateral (or medial in some cases) wedged foot orthotics through decreasing of pressure in medial (or lateral) compartment of the knee can lead to significant pain relief, and are a good choice for every patient suffering from knee osteoarthritis, especially those who have serious side effect of pharmacological therapy, and who are not candidates for (or refuse) surgery. One degree of applied lateral or medial wedge along the full length of the insole changes Q-angle for 0.44 degrees. We developed comprehensive system with ability of digital image acquisition, orthoses design and tool path generation for numerically controlled machine tool. The process begins with digital imaging of the plantar surface of the foot. This image is transformed into a 3D surface that matches the topography of the plantar aspect of the foot. A user-friendly software package is then used to modify the images according to the clinical purpose of the orthosis defined by the physician. Once designed, a tool path for the CNC milling machine is defined and the outer portion of the insole is milled. The only hand work necessary is application of a soft covering and trimming the insole to fit within a shoe.

knee osteoarthritis; foot orthotics; CAD/CAM; CNC machine tool

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