Jim Newman looks at a new device that could benefit osteoarthritis patients who do not want or cannot have knee surgery.

We tend to talk about the various treatment approaches to osteoarthritis as though patients are on a sort of conveyor belt. What starts with painkillers and modifying activity eventually progresses to cortisone injections until you finally reach the end of the care pathway and a knee replacement is the last remaining option. For many patients, this is exactly how their experience plays out.

Yet for some patients, perhaps those who are particularly frail or too young, a total knee replacement may be required but, for reasons of practicality or risk, can’t happen. Other patients, irrespective of the clinical advice and the pain they experience every day, simply don’t want a knee replacement.

For all the above, options are limited to therapeutic exercise, weight loss (to relieve pressure on the joint) and perhaps a knee brace and walking stick. Now, there’s an additional option.

Apos – the adapted shoe

Towards the end of 2022, the National Institute for Health and Care Excellence (NICE) issued a draft recommendation supporting the use of a foot-worn device which looks like a trainer. The Apos® shoe aims “to improve the biomechanics of the person wearing them by redistributing pressure away from affected areas, reducing knee pain”. In terms of pain relief, this can make an important contribution.

The shoe works to aid alignment. If you’re someone whose weight goes through the inside of the knee (as is the case with most people) and this is compounded by a foot position that has led to an abnormal walking pattern, you’ll be placing weight on your knee in a way that exacerbates pain.
If you can change the foot position and re-educate muscles, you can correct the abnormal walking position and relieve the load on the knee.

This is the effect of the rubber ‘pods’ on the soles of the Apos®, the positioning of which can be adapted to suit each specific patient. The cost of the trainer and associated treatment is quoted as being £875 per person, but this is relatively cheap compared to alternative non-operative treatment costs.

> Discover more about AposHealth & their shoes

Does the adapted shoe work?

As the draft recommendation notes, “Clinical evidence from a high-quality randomised controlled trial shows that the Apos® shoes improves scores for measuring pain, stiffness and function when compared with a sham device.”

This is good news, and I’m all for any non-surgical option which might help alleviate pain. Yet it is important to see the benefits of the shoe for what they are. The shoe is a potentially worthwhile tool for those who can’t have a knee replacement. Although not mentioned in the recommendation, I can imagine it having a beneficial effect on those with mild arthritis too. But where a knee replacement is a safe and reasonable treatment option, it remains the better option.

To talk about your knee replacement, please get in touch, or phone us on 03453 052 579.

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