This study aims to investigate the effects of textured insoles on balance, physical performance, and plantar pressure distribution in older adults with medial compartment knee osteoarthritis. Participants will be randomly assigned to two groups: the intervention group will receive textured insoles, while the control group will receive flat insoles without texture. Both groups will use their respective insoles for 4 weeks in their daily life. The study includes pre- and post-intervention assessments using balance platforms, functional performance tests (such as the Timed Up and Go, 30-second Chair Stand Test, and Step Test), and plantar pressure analysis. This randomized controlled study is designed to evaluate the effectiveness of textured insoles as a non-invasive and easily applicable rehabilitation method in improving balance and pressure distribution in elderly individuals with knee osteoarthritis.

This randomized controlled trial will include older adults aged 65 and over who have been diagnosed with medial compartment knee osteoarthritis according to the American College of Rheumatology criteria and have radiological evidence (Kellgren-Lawrence grade 2 or 3).

Eligible participants will be randomly assigned into two groups: a textured insole group and a flat insole group. Participants will wear the insoles in their daily footwear for a period of 4 weeks.

Baseline and follow-up assessments will include:

• Static and dynamic plantar pressure distribution using the Diasu® baropodometric system.
• Balance assessment using the HUR Smart Balance platform under four conditions (eyes open, eyes closed, eyes open on unstable surface, eyes closed on unstable surface).
• Functional performance tests: Timed Up and Go (TUG), 30-second Chair Stand Test, and Step Test.
• Disease-specific questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS).
• Q-angle and knee proprioception measurement. Data will be analyzed to determine whether the use of textured insoles improves balance, physical performance, and plantar pressure distribution more effectively than flat insoles in older individuals with knee osteoarthritis.

Inclusion Criteria:

• Aged between 65 and 75 years
• Diagnosed with medial compartment knee osteoarthritis
• Able to walk independently without assistive devices
• Having foot size compatible with available insole sizes
• Volunteering to participate in the study and providing informed consent

Exclusion Criteria:

• Diagnosed with neurological diseases (e.g., stroke, Parkinson's disease, multiple sclerosis)
• Diagnosed with vestibular disorders or balance problems due to inner ear issues
• Having a history of lower extremity surgery in the past year
• Severe foot deformity that prevents insole use
• Having visual impairment that is not corrected with glasses
• Currently using a walking aid (cane, walker, etc.)
• Cognitive impairment or inability to follow instructions

There is currently no plan to share individual participant data (IPD) due to the study's limited scope and ethical considerations. Data sharing might be considered in the future upon justified request and with appropriate ethical approval.

No parties were masked due to the nature of the intervention.