Osteoarthritis (OA) of the knee affects an estimated 20–40% of individuals over the age of 65 [1], and is nearly 10 times more common in the medial compartment than the lateral compartment [2]. Many studies have reported the effectiveness of footwear modifications using laterally-wedged insoles [3,4] and more recently, variable-stiffness soles [5] in reducing the adduction moment at the knee in patients with medial compartment knee OA. The adduction moment is known to be associated with the progression [6] and treatment outcome [7] of medial compartment knee OA, and has been shown to be correlated with medial compartment joint loading [8]. However, the exact changes in medial compartment joint loading in vivo with the variable-stiffness shoe remain unknown. The development of an instrumented total knee implant which has the ability to directly measure tibial forces, and can differentiate between medial and lateral joint loads in vivo during walking [9], allows the testing of changes in the medial compartment loading with an intervention shoe.

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