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2 The technology


2.1 AposHealth (AposHealth, previously AposTherapy) is a non-invasive device worn on the feet. The device consists of a pair of AposHealth shoes with 2 curved pods (pertupods) on the heel and forefoot of each shoe. The pertupods are securely attached to tracks on the bottom of the shoe with screws. Positioning of the pertupods is done by trained healthcare professionals and can be aided by gait analysis software or hardware.

2.2 The AposHealth 4-step treatment plan lasts 1 year and consists of an initial patient assessment, personalisation of the device, at-home treatment and ongoing monitoring. The at-home treatment step involves the person wearing the device for short periods of time during daily activities, for a total of up to 60 minutes per day.

Care pathway

2.3 Treatment of knee osteoarthritis depends on the severity of symptoms. Current treatment options include pharmacological and non-pharmacological treatments.

2.4 Non-pharmacological core treatments for osteoarthritis are therapeutic exercise and weight loss (if appropriate), along with information and support. NICE's guideline on the diagnosis and management of osteoarthritis recommends tailoring information to the individual needs of people with osteoarthritis, their families, and carers, and ensuring it is in an accessible format. Other non-pharmacological treatment options include manual therapy (such as manipulation, mobilisation or soft tissue techniques), and devices (such as walking aids).

2.5 Pharmacological treatment options include topical and oral non-steroidal anti-inflammatories (NSAIDs) to relieve pain and inflammation. Intra-articular corticosteroid injections should be considered when other pharmacological treatments are ineffective or unsuitable, or to support therapeutic exercise. However, these treatments only provide short-term relief and may become less effective as the severity of knee osteoarthritis increases. NICE's interventional procedures guidance on platelet-rich plasma injections for knee osteoarthritis says that this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

2.6 Referral for knee surgery should be considered for people who experience joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) that have a substantial impact on their quality of life, and non-surgical management is ineffective or unsuitable. Clinical assessment should be used when deciding to refer someone for joint replacement, instead of systems that numerically score severity of disease.

Innovative aspects

2.7 AposHealth is intended to improve biomechanics by redistributing pressure away from affected areas and reduce knee pain. On a neuromuscular level, it is designed to re-educate muscles and correct abnormal gait patterns, which can extend to when the person is not actively wearing the device.

Intended use

2.8 AposHealth is intended for use by people 16 years and over with knee osteoarthritis who have had non-surgical standard care that has not worked well enough.


2.9 AposHealth costs £875 (excluding VAT) per treatment programme for both knees. The treatment programme includes:

  • AposHealth shoes and unlimited parts

  • access for healthcare professionals to standardised outcome measures on the AposHealth clinical tracking system

  • training for healthcare professionals (typically consists of 6 hours theory training, and 5 to 10 observed calibrations that are delivered as part of routine service provision).

For more details, see the website for AposHealth for osteoarthritis of the knee.