Foot Orthotics for Knee Osteoarthritis: What the Evidence Shows for Lateral Wedges

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

▶ Watch

Medial compartment knee osteoarthritis — the most common location for knee OA — produces a characteristic varus alignment that increases the medial compartment loading moment, accelerating cartilage loss on the medial side. Lateral wedge foot orthotics, by pronating the foot and reducing the knee adduction moment (KAM), offer a potential non-surgical intervention to reduce medial compartment loading. Understanding what the evidence actually shows — and where the initial enthusiasm for lateral wedges has been tempered by long-term data — helps patients make informed decisions.

Biomechanical Rationale

A lateral heel wedge (typically 5–10 degrees) pronates the subtalar joint, shifts the ground reaction force vector laterally, and reduces the external knee adduction moment — the primary load parameter correlated with medial compartment OA progression. Biomechanical studies consistently demonstrate 4–8% reduction in peak KAM with 5-degree lateral wedging in controlled laboratory settings. The question is whether this biomechanical effect translates to clinically meaningful pain reduction and OA progression slowing in real-world patients.

Clinical Evidence: The Current Consensus

Initial small trials in the 2000s showed promising pain reduction with lateral wedge insoles. However, larger and higher-quality trials have been less consistent. The pivotal BRAKES trial (BMJ, 2011) — a multicenter RCT comparing lateral wedge insoles to flat insoles — found no significant difference in pain, function, or OA progression at 12 months. A 2020 Cochrane systematic review of 12 RCTs concluded that lateral wedge insoles provide little to no clinically important benefit over flat insoles for knee OA pain, though a subset of patients with isolated medial compartment OA and significant varus alignment may derive modest benefit. The current evidence does not support lateral wedge orthotics as a standard treatment for medial compartment knee OA, though they remain a reasonable low-risk adjunct for individual patients who experience symptomatic benefit.

Custom Orthotics in the Context of Knee OA

Custom foot orthotics provide biomechanical correction beyond what lateral wedging alone offers — addressing concurrent foot deformity (pes planus, hallux valgus) that may contribute to altered lower extremity alignment and knee loading. In patients with significant pes planus combined with medial compartment knee OA, custom orthotics addressing the flatfoot may provide more benefit than isolated lateral wedging. Dr. Biernacki at Balance Foot & Ankle evaluates foot biomechanics in the context of knee pain and provides custom orthotics when indicated by clinical examination. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

📧 Get Dr. Tom’s Free Lab Test Guide

Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.

Download Your Free Guide →

📍 Located in Michigan?

Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.

Book Now →
(810) 206-1402

When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

Related Conditions & Resources

• All Treatments
• Plantar Fasciitis
• Neuropathy Treatment
• Custom Orthotics

View All Treatments →

Ready to Get Relief? We’re Here to Help.

Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

📅 Book Online
📞 (810) 206-1402

Custom Orthotics for Knee Pain in Michigan

Research shows that foot orthotics can significantly reduce knee osteoarthritis pain. Our podiatrists create custom devices that address the biomechanical link between your feet and knees.

Explore Our Custom Orthotic Solutions → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Hinman RS, Bennell KL. Advances in insoles and shoes for knee osteoarthritis. Curr Opin Rheumatol. 2009;21(2):164-170.
2. Rafiaee M, Karimi MT. The effects of various kinds of lateral wedge insoles on performance of individuals with knee joint osteoarthritis: a literature review. J Med Eng Technol. 2012;36(6):275-285.
3. Chapman GJ, Parkes MJ, Sherrington C, et al. Podiatric assessment and intervention for knee osteoarthritis: a review and conceptual model. Rheumatology. 2019;58(8):1337-1351.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.