Dr. Lidtke's Remarks (George C. Trachtenberg, MS, DPM)
I am not sure what Dr. Trachtenberg means by "all the research." All the research is available at ncbi.nlm.nih.gov/pubmed
I am a clinician and a researcher. As a researcher, I use the scientific method to establish a finding at the 95% confidence level that the finding is true. At Rush University, we do NIH-sponsored level of research and publish in journals that have a high impact factor where the editors and reviewers make sure our methodology and conclusions are correct.
So, as a researcher, I can tell you that wearing the Flex OA shoe does decrease the loads on the medial compartment of the knee around 20%. As a scientist, I cannot tell you the mechanism of action as of yet. This is the current area of research we are working on. As a clinician, I must decide what treatment is best for each of my patients individually based on the available information.
The conservation of energy theorem is probably not the correct analogy for cell destruction in osteoarthritis as much of the external energy of gait is taken up into joint motion and internal muscular contraction and has not been proven to be an acceptable biomarker for osteoarthritis. The external knee adduction moment has been shown to be a good biomarker for knee OA and is dependent on the magnitude and orientation of the ground reaction force vector.
While the magnitude of the ground reaction force is dependent on the body mass and gravity (not easily altered), the direction of the vector can be altered. The observed gait with the Flex OA shoe demonstrates that the ground reaction force vector functions closer to the instantaneous center of rotation of the knee joint thereby reducing the lever arm that is causing the greater moment of force to load the medial compartment of the knee.
Roy H. Lidtke, DPM, Chicago, IL, Roy.Lidtke@dmu.edu
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