Biomechanical factors have a critical role in the onset and progression of osteoarthritis (OA). A recent carefully designed, randomized, controlled trial by Rodrigues and colleagues examined the use of an 8 mm medial-wedge insole for the management of lateral compartment knee OA associated with a valgus deformity. In this study the use of a wedged insole, together with ankle straps to provide ankle stability, was associated with substantial improvements in pain and functional status compared with a control, neutral insole; however, the trial sample size was small. Previous studies on lateral-wedge insoles for medial compartment knee OA have had conflicting results. Until larger, more-definitive trials are conducted, it would be reasonable for clinicians to provisionally recommend medial-wedge insoles for patients with lateral knee OA and a valgus deformity.