Musculoskeletal (MSK) conditions are the leading cause of pain and disability in England, accounting for one of the highest causes of sickness absence and productivity loss across the country. According to Government research less than 20% of people aged 16 and over are self-reporting for long term pain issues, meaning people are continuing to live with pain. [1.]

Chronic knee pain is common in MSK conditions, and often a sign of osteoarthritis. Previously patients had little choice but to have invasive steroid injections or surgery, which some patients are reluctant to accept.

Apos® – a non-invasive treatment for patients with knee pain

Patients in Greater Manchester are experiencing life-changing care for the treatment of osteoarthritis and chronic knee-pain by using the Apos^® device, a NICE recommended clinical innovation that is supported by the MedTech Funding Mandate 2024/25.

Apos^® is a non-invasive medical device combined with a treatment plan worn on the patient’s feet for up to one hour a day to help reduce pain and improve daily function. By considering each patient’s unique anatomy, biomechanics, neuromuscular responses, and medical history, Apos® delivers personalised treatment tailored to individual needs – resulting in significant improvements in pain relief, functional ability, and quality of life.

The custom calibrated curved pods on the heel and forefoot of each shoe help the user to retrain the muscles in their legs whilst redirecting the force away from painful areas of the knee. The calibration and fitting is done by a trained healthcare professional, as part of a consultation and can be aided by gait analysis software or hardware.

Apos® is recommended as a cost-saving treatment for patients who have met the referral criteria for knee replacement surgery but would like a non-surgical alternative.

How the Apos® device is changing people’s lives in Wigan

In Wigan, Greater Manchester, a number of users have seen improvement in their movement and in their overall health and wellbeing since using the Apos® device.

Beverley from Atherton and Jeff from Wigan are two Apos® device users who have seen significant improvements in their knee-pain, following a consultation and a gait analysis session to be fitted for their shoes.

Both Beverley and Jeff had experienced chronic knee-pain which was impacting on their daily lives, and have experienced first-hand how the Apos® device can have life-changing impacts in a short space of time.

Beverley, who experienced a fall whilst carrying her grandson up a flight of stairs, self-referred to physiotherapy and was put in touch with the opportunity for an Apos® device consultation through her work at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust.

Jeff, was referred to the Apos® device following a consultation with an orthopaedic nurse after living with chronic knee pain for several years. His daily life had become difficult due to the pain that he was experiencing, however since wearing the Apos® shoes he has seen huge improvements in his ability to walk pain-free, walk up and down stairs, which he admitted he wouldn’t have dreamt about at one time.

Cath Barrow, Senior Programme Development Lead at Health Innovation Manchester, said: “Understanding the patient perspective is an important part of any innovation journey.  To give patients an alternative option whilst they’re waiting for surgery or unable to have surgery has massive benefits for them especially on quality of life.  Having an innovation like Apos® may be part of the solution to improve population health outcomes and reduce health-related economic inactivity.”

Julian O’Kelly PhD, MTFM National Product Lead for Apos®, Health Innovation Kent Surrey Sussex, said: “These case studies really bring to life the transformative benefits of Apos for people who suffer with the pain and mobility effects of knee osteoarthritis. It’s been great to witness how the Health Innovation Network has worked in partnership with healthcare providers across the country to support the spread of this game changing innovation.”

Chris Miles, Head of Clinical Services at Apos®, said: “Adding the Apos® device to the knee osteoarthritis care pathway has truly transformed how clinicians can approach this long-term condition. It gives patients a meaningful choice in their care, empowering them to take control of their health, while also providing health systems with an effective solution to manage a growing population. Working closely with local NHS providers and the Health Innovation Network team in Greater Manchester has been an invaluable experience, helping us deeply understand the local system and successfully integrate this innovation within the NHS.”

Adam Ball, Clinical Special Orthotist at TalarMade, said: “Since Apos® was NICE recommended, as an Orthotist working with numerous patients with knee osteoarthritis, I felt it was essential to explore and understand its potential benefits and I am so glad I did. Since introducing Apos® into our orthotics clinic at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust over 12 months ago, it has added real value to our service and significantly improved the lives of many patients.

“Treating each patient holistically is crucial, which is why we discuss both knee bracing and Apos® as potential options. By providing patients with a choice, we empower them to take an active role in their treatment decisions. Our clinical evidence and outcome measures clearly demonstrate the benefits of Apos®, showing improvements in function, quality of life, and pain reduction. While Apos® may not be suitable for every patient, it has become a valuable addition to my clinical toolkit, allowing me to offer more tailored treatment options for this patient group.”

Emma Lawler, Project Lead for Community Specialist Services at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, said: “Apos® has been a fantastic addition the range of appliances we use in Wigan, giving our patients another option to choose from when it comes to managing knee osteoarthritis. The improvements I have seen have been nothing short of amazing, with patients commenting on what aspects of their life they are now able to return to, such as cycling and playing with the grandkids. The process from assessment to provision of footwear is quick and easy, and as we have the full equipment to perform assessments and reviews within any clinic setting, has now become a much-used tool for dealing with knee osteoarthritis patients.”

Masterclass – An introduction to Apos®

As part of the support for the Apos® device, Health Innovation Manchester hosted a masterclass session at Citylabs 1.0 in January 2025 to showcase the findings from the benefits that have been captured to date, and to discuss how this is impacting on services like Wigan, including pathway analysis and procurement.

Colleagues from NHS Supply Chain, Apos^®, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Manchester University NHS Foundation Trust (MFT) and Health Innovation Manchester analysed the real-world benefits that this solution has had on patient’s lives and were presented to on the improved health economics outcomes that Apos® has achieved.

References:

1. https://www.gov.uk/government/statistics/musculoskeletal-health-local-profiles-january-2024-update/musculoskeletal-health-local-profiles-short-commentary-january-2024