Sixty-two patients with early medial compartment osteoarthritis of the knee were treated with lateral heel wedges and followed for from 7 years and 5 months to 12 years. Those who were treated with heel wedges and analgesics showed a significantly greater improvement in pain score than those treated with analgesics only, but not in the walking ability score at the second follow up. The lateral heel wedge had no effect on the progress of the radiographic changes. The lateral heel wedge is useful for patients with early medical compartment osteoarthritis provided it is used with an understanding of the indications and its limitations.