Foot orthoses for the treatment of patellofemoral pain

FOOT ORTHOSES FOR THE

TREATMENT OF PATELLOFEMORAL

JOINT PAIN

Isaac Knott

Student ID: u3068884

FOOT ORTHOSES FOR THE TREATMENT OF

PATELLOFEMORAL JOINT PAIN

Prevalence = approximately 26% active population [1].

Pain in retro-patellar (behind) or peri-patella (around) [1].

Pain brought on through an increased load through the patellofemoral joint [1-3].

Prolonged walking, ascending/descending stairs, running, kneeling, squatting, prolonged sitting…

Image 1: Moveforwardpt.com. Patellofemoral Pain - MoveForwardPT.com [Internet]. 2014 [cited 14 September 2014]. Available from: http://www.moveforwardpt.com/symptomsconditionsdetail



Image 2: My Trainer Chris. Knee Strengthening for Females [Internet]. 2013 [cited 14 September 2014]. Available from: http://mytrainerchris.wordpress.com/2013/12/21/knee-strengthening-for-females/



“Conservative management is currently considered the principle

treatment, with foot orthoses often prescribed in combination or as an alternative to other management

strategies including taping, exercise prescription and analgesics(2)”.



Foot orthoses are specially moulded devices designed to fit inside footwear (1).

Many different variations and styles

Custom vs prefabricated

Hard, medium or soft

Corrects foot posture and improves lower limb biomechanics thereby decreasing PFJ pain? (1,3)

Image 3 & 4: Soleplatinum.blogspot.com.au. Sole Solutions: Custom Foot Orthotics Laboratory in Cayman! [Internet]. 2011 [cited 14 September 2014]. Available from: http://soleplatinum.blogspot.com.au/2011/06/custom-foot-orthotics-laboratory-in.html



Why is it important?

High prevalence Decreases functional performance Potential to contribute to additional chronic conditions (e.g

osteoarthritis) Physiotherapists on the “frontline” in terms of treating such

conditions Orthotics widely available



EvaluationStrengths

Clearly defined research question. Extensive search for relevant

papers using strict inclusion and exclusion criteria.

Methods for each of the included trials were evaluated for bias.

Results interpreted with appropriate applications for clinical practice.

Protocols implemented to reduce the risk of bias through the selection and review process.

Weaknesses

Only two articles were examined

Prevented assessments of heterogeneity and sensitivity

Neither of the reviewed trials had a clearly defined control group.



EvaluationStrengths

Systematic review – did include some RCT’s

Larger number of studies and participants

Weaknesses

Broad and multifaceted research question

Included case series and other lower quality study designs

Poor study design, poorly defined outcome measures and a lack of quantifiable data from the included studies.

Little to no comparison between studies

High risk of bias in included studies

No clear conclusions drawn



EvaluationStrengths

Clearly defined control

Clear conclusion drawn

Well-designed methods that attempted to limit possible sources of bias (e.g. Blinding)

Weaknesses

Low participant numbers

Shorter duration (6wks)

Orthoses supplied by prominent international manufacturer. Bias?



Summary

Evidence around this topic seems to be conflicting

Higher levels of evidence seem to indicate that orthoses have little impact on PFJ pain over the long-term but there is a potentially a positive impact over the short term.

Clear that there is a lack of high quality, well designed trials addressing this topic.



What did I learn?

Patience. How to better recognise good quality evidence. A better ability to recognise potential sources of bias. The ability to recognise the clinical significance and

potential impact of a good quality article.



Thank you!

Any Questions ?

Email: [email protected]



References

1.Hossain M, Alexander P, Burls A, Jobanputra P. Foot orthoses for patellofemoral pain in adults. Cochrane Database Syst Rev. 2011;1.

2.Barton MCJ, Munteanu SE, Menz HB, Crossley KM. The efficacy of foot orthoses in the treatment of individuals with patellofemoral pain syndrome. Sports Medicine. 2010;40(5):377-95.

3.Mills K, Blanch P, Dev P, Martin M, Vicenzino B. A randomised control trial of short term efficacy of in-shoe foot orthoses compared with a wait and see policy for anterior knee pain and the role of foot mobility. British Journal of Sports Medicine. 2011:bjsports-2011-090204.

4.Nhmrc.gov.au. Resources for guideline developers | National Health and Medical Research Council [Internet]. 2014 [cited 14 September 2014]. Available from: https://www.nhmrc.gov.au/guidelines/resources-guideline-developers

Foot orthoses for the treatment of patellofemoral pain

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