National Institute for Health and Clinical Excellence (NICE)
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NICE recommends adapted shoes for people with severe osteoarthritis

People with osteoarthritis who are eligible for knee surgery could be offered specially adapted shoes to help with their painful and stiff knees following a draft recommendation by NICE.

Apos, a foot worn device which looks like a trainer and developed by AposHealth, aim to improve the biomechanics of the person wearing them by redistributing pressure away from affected areas, reducing knee pain. 

NICE has launched a consultation on draft medical technologies guidance on the use of shoes that are fitted with rubber ‘pods’ on the soles which help to re-educate muscles and correct abnormal walking patterns.

A trained healthcare professional positions the pods after analysis of walking patterns to ensure the shoes are adapted to the individuals’ requirements.

Analysis seen by the independent NICE medical technology advisory committee shows the shoes could potentially save the NHS £1,958 per person when compared with standard care over five years. The cost for the footwear and associated treatment from trained professionals is estimated at £875 per person.

The committee has recommended Apos footwear for people for whom non-surgical standard care has not worked well enough and who meet the referral criteria for total knee replacement surgery but cannot have, or do not want, surgery.

Mark Chapman, interim director of Medical Technology at NICE, said: “People with osteoarthritis of the knee can be in considerable pain going about their day-to-day lives and the evidence seen by our committee suggests this can be improved by wearing these shoes.

“This recommendation will not only save the NHS money by balancing the best care with value for money, but it will also put a new innovation into the hands of health and care professionals to enable best practice.”

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. The committee has called for further data to be collected, however, on quality of life, health resource use and long-term surgical outcomes for people with knee osteoarthritis who meet the criteria for total knee replacement surgery, but who cannot have or do not want total knee replacement surgery and are using the Apos in the NHS.

At present people with osteoarthritis of the knees could be offered aids (such as walking sticks) alongside NICE-recommended therapeutic exercise (local muscle strengthening, general aerobic fitness) and weight loss (if appropriate) as non-pharmacological management standard care. 

Osteoarthritis is the most common type of arthritis in the UK and a condition that causes joints to become painful and stiff. It is estimated that one in five people aged over 45 have knee osteoarthritis in England, with 38,983 knee procedures taking place in England in 2021 according to the National Joint Registry.

NICE medical technologies guidance helps people in the NHS make efficient, cost-effective and consistent decisions about adopting new medical technologies. As it does not include a funding mandate, it is up to local commissioners to decide whether to implement our recommendations.

The consultation has now begun on the recommendations at until Monday 12th December 2022.


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