Bracing and orthoses: a review of efficacy and mechanical effects for tibiofemoral osteoarthritis.

The knee is the weight-bearing joint most commonly affected by osteoarthritis. Bracing of the knee or the foot can be a useful nonoperative and nonpharmacologic treatment for persons with osteoarthritis that predominantly involves either the medial or lateral tibiofemoral compartment. The aim of wedged insoles and realigning knee braces is to reduce articular contact stress in the more involved tibiofemoral compartment. There is evidence that even knee sleeves that do not have an effect on alignment may confer symptomatic relief and enhance joint position sense. This review summarizes the current state of knowledge regarding the degree to which bracing at the knee or foot can effectively correct tibiofemoral malalignment, improve knee joint pain, and enhance physical function, and provides clinical recommendations for prescription of these devices to optimize effectiveness.