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Foot orthoses and patellofemoral pain syndrome

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  #31  
Old 24th April 2012, 02:59 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

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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.
Mills K, Blanch P, Dev P, Martin M, Vicenzino B.
Br J Sports Med. 2012 Mar;46(4):247-52
Quote:
OBJECTIVES:
To investigate the short-term clinical efficacy of in-shoe foot orthoses over a wait-and-see policy in the treatment of anterior knee pain (AKP) and evaluate the ability of foot posture measures to predict outcome.

DESIGN:
Single-blind, randomised control trial.

PARTICIPANTS:
Forty participants (18-40 years) with clinically diagnosed AKP of greater than 6-week duration, who had not been treated with orthoses in the previous 5 years.

INTERVENTION:
Prefabricated orthoses perceived as most comfortable from a selection of 3 different hardness values compared with a wait-and-see control group.

OUTCOME MEASURES:
Participant-perceived global improvement, Kujala Patellofemoral Score, usual and worst pain severity over the previous week and the Patient Specific Functional Scale measures at 6 weeks.

RESULTS:
Foot orthoses produced a significant global improvement compared with the control group (p = 0.008, relative risk reduction = 8.47%, numbers needed to treat = 2). Significant differences also occurred in measures of function (standardised mean difference = 0.71). Within the intervention group, individuals who exhibited a change in midfoot width from weight bearing to non-weight bearing of >11.25 mm were more likely to report a successful outcome (correct classification 77.8%).

CONCLUSION:
This is the first study to show orthoses provide greater improvements in AKP than a wait-and-see approach. Individuals with greater midfoot mobility are more likely to experience success from treatment.
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  #32  
Old 21st July 2012, 12:56 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females with and without Patellofemoral Pain Syndrome.
Boldt AR, Willson JD, Barrios JA, Kernozek TW.
J Appl Biomech. 2012 Jul 5.
Quote:
We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group (PFPS, control) x condition (medial wedge, no medial wedge) x standing calcaneal angle (everted, neutral, inverted)) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = 0.03) and hip adduction excursion decreased 0.6° (P <0.01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.
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  #33  
Old 7th November 2012, 12:47 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

Medially posted insoles consistently influence foot pronation in runners with and without anterior knee pain
Pedro Rodrigues, Ryan Chang, Trampas TenBroek, Joseph Hamill
Gait and Posture (in press)
Quote:
Anterior knee pain (AKP) is a common injury among runners and effectively treated with posted insoles and foot orthotics. While clinically effective, the underlying biomechanical mechanisms that bring about these improvements remain debatable. Several methodological factors contribute to the inconsistent biomechanical findings, including errors associated with removing and reattaching markers, inferring foot motion from markers placed externally on a shoe, and redefining segmental coordinate systems between conditions. Therefore, the purpose of this study was to evaluate the influence of medially posted insoles on lower extremity kinematics in runners with and without AKP while trying to limit the influence of these methodological factors. Kinematics of 16 asymptomatic and 17 runners with AKP were collected while running with and without insoles. Reflective markers were attached to the surface of the calcaneus and kept in place (as opposed to detached) between conditions, eliminating the error associated with reattaching markers and redefining segmental coordinate systems. Using these methods, no significant interactions between insole and injury and the main effect of injury were detected (p>0.05); therefore, means were pooled across injury. Insoles, on average, reduced peak eversion by 3.6° (95% confidence interval −2.9° to −4.3°), peak eversion velocity by 53.2°/s (95% confidence interval −32.9 to −73.4) and eversion range of motion by 1.33 (95% confidence interval −0.8 to −1.9). However, while insoles systematically reduced eversion variables, they had small influences on the transverse plane kinematics of the tibia or knee, indicating that they may bring about their clinical effect by influencing other variables.
Quote:
Highlights
► Studies have not shown motion controlling devices to consistently affect lower extremity biomechanics.
► Several methodological factors may contribute to these inconsistencies.
► These factors include placing markers externally on a shoe and redefining segmental coordinate systems between conditions.
► When limiting the influence of these methodological factors medially posted insoles consistently reduce foot pronation variables.
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  #34  
Old 7th March 2013, 06:30 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

Effects of medially wedged foot orthoses on knee and hip joint running mechanics in females with and without patellofemoral pain syndrome.
Boldt AR, Willson JD, Barrios JA, Kernozek TW.
J Appl Biomech. 2013 Feb;29(1):68-77.
Quote:
We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.
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  #35  
Old 7th March 2013, 06:38 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

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with and without a 6° full-length medially wedged foot orthoses
Why that? Why not use "foot orthotics of the type that are commonly used in clinical practice"?
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  #36  
Old 10th March 2013, 04:48 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

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Why that? Why not use "foot orthotics of the type that are commonly used in clinical practice"?
I in a bad mood today, so this paper gets the dumbass piece of research for the week. I finally got the full paper; the "orthoses" was a full length 6 degree EVA wedge ... who does that clinically? really dumb to use something that is not used clinically. To make it worse, the authors said in the discussion that the 6 degree wedge was to ".....elevate the first metatarsal head ..."! What were they thinking? duh? Have they not heard of the windlass mechanism that this would have inhibited and made the foot pronate even more ... really dumb! That total invalidates the study and makes the results meaningless.
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  #37  
Old 8th April 2014, 08:21 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

The effects of three quarter and full length foot orthoses on patellofemoral pain sufferers when walking and descending stairs
Jim Richards, John Burston and James Selfe
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A70 doi:10.1186/1757-1146-7-S1-A70
Quote:
Background
Patellofemoral pain is a common disorder whose aetiology is multifactorial and is often attributed to foot function. Foot orthoses are commonly prescribed for this condition; however the mechanisms by which they work are poorly understood. Previous studies using single segment foot models have hypothesised that it may be control of the midfoot which holds the key to understanding orthotic control. Over the last decade it has become possible to divide the foot into multiple segments, however little work exists investigating the use of orthoses on different segments of the foot in this patient group. The aim of this study was to investigate the differences in the kinematics and kinetics of the lower limb during walking and step descent between patellofemoral patients and normal subjects and the effect of ¾ and full length foot orthoses versus no intervention.

Method
Kinematic and kinetic data were recorded from 15 healthy subjects and 15 patients diagnosed with patellofemoral pain using 10 Oqus cameras and 4 AMTI force platforms. Subjects were asked to walk at a self-selected pace and complete a 20cm step down. The foot was modelled using a three segment 6 degrees of freedom model by fixing the marker set directly to the shoes and the lower limb was modelled using the calibrated anatomical systems technique.

Results
Significant differences were seen between the healthy subjects and the patellofemoral pain patients during both tasks at the midfoot and rearfoot movement in the sagittal and coronal planes (p=0.003 to 0.016); at the knee joint significant differences were seen in the sagittal, coronal and transverse plane movement (p=0.001 to 0.01); and in the moments about the ankle and knee joints in the sagittal and coronal planes (p=0.012 to 0.035). The orthoses produced statistically significant differences in the movement in the forefoot, midfoot and rearfoot across all three planes for both tasks (p=0.001 to 0.032). The orthoses showed no change in the knee kinematics, although a significant reduction in the knee coronal plane moments during step descent was seen in both the ¾ and full length foot orthoses (p=0.019, p=0.028).

Conclusions
Despite placing markers on the shoes this study was able to detect significant differences within the foot segments and identified potentially clinically important differences between patellofemoral pain patients and normal subjects and was able to determine clinical important changes due to treatment.
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  #38  
Old 14th April 2014, 10:02 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

Masters thesis from 2000:

THE EFFECTIVENESS OF USING FOOT ORTHOTICS AS THE SOLE
INTERVENTION FOR THE TREATMENT OF PATELLOFEMORAL PAIN
SYNDROME

Byron Horner; Grand Valley State University
Source
Quote:
Patellofemoral pain syndrome (PFPS) is a common diagnosis treated by health
care personnel. This study investigates the effectiveness of foot orthotics in the treatment
of PFPS. Fourteen subjects experiencing PFPS participated. Each completed a
Functional Pain Assessment (FPA) consisting of walking, stairs, biking, squatting and
resting (sitting). Function was assessed using the Activities of Daily Living Scale
(ADLS). After the initial FPA and ADLS. foot orthotics were placed in the shoes of
participants and worn for the duration of the study. No other intervention was given.
Follow-up testing was performed immediately after insertion of orthotics, after two
weeks and again at four weeks in which subjects completed the FPA and ADLS. Results
indicate that orthotics do not immediately decrease pain (p=.29). However, after two and
four weeks, significant improvement was found (p=.004, p=.002) respectively.
Functional improvements were found at both two and four weeks (p=.042. p=.014)
respectively. This study does support the use of orthotics in the treatment of PFPS.
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  #39  
Old 15th April 2014, 04:23 AM
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Default Re: Foot orthoses and patellofemoral pain syndrome

No control group. Stabilizer orthotic with only 2 degrees of varus posting. Small sample size and small length of follow up. Was he just pandering to someone at his PT school who really think orthotics don't help?
Why do we keep testing OTC devices expecting different outcomes tha previously tested?
This is poor science.
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  #40  
Old 29th August 2014, 12:55 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

The immediate effects of foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in individuals with patellofemoral pain
Simon Lack, Christian Barton, Roger Woledge, Markus Laupheimer, Dylan Morrissey
Clinical Biomechanics; Articles in Press
Quote:
Highlights
•Orthoses are effective in PFP management however mechanism(s) is poorly understood
•We explore mechanisms of foot orthoses effects during a stepping task in individuals with PFP
•Foot orthoses result in immediate changes in hip and knee kinematics
•Gluteal amplitude is reduced following orthoses application
•Lower limb muscle onsets are unchanged immediately post orthoses application
Quote:
Background
Evidence shows that anti-pronating foot orthoses improve patellofemoral pain, but there is a paucity of evidence concerning mechanisms. We investigated the immediate effects of prefabricated foot orthoses on (i) hip and knee kinematics; (ii) electromyography variables of vastus medialis oblique, vastus lateralis and gluteus medius during a functional step up task, and (iii) associated clinical measures.

Methods
Hip muscle activity and kinematics were measured during a step-up task with and without an anti-pronating foot orthoses, in people (n = 20, 9 M, 11 F) with patellofemoral pain. Additionally, we measured knee function, Foot Posture Index, isometric hip abductor and knee extensor strength and weight-bearing ankle dorsiflexion.

Findings
Reduced hip adduction (0.82°, P = 0.01), knee internal rotation (0.46°, P = 0.03), and gluteus medius peak amplitude (0.9 mV, P = 0.043) were observed after ground contact in the ‘with orthoses’ condition. With the addition of orthoses, a more pronated foot posture correlated with earlier vastus medialis oblique onset (r = −0.51, P = 0.02) while higher Kujala scores correlated with earlier gluteus medius onset (r = 0.52, P = 0.02).

Interpretation
Although small in magnitude, reductions in hip adduction, knee internal rotation and gluteus medius amplitude observed immediately following orthoses application during a task that commonly aggravates symptoms, offer a potential mechanism for their effectiveness in patellofemoral pain management. Given the potential for cumulative effects of weight bearing repetitions completed with a foot orthoses, for example during repeated stair ascent, the differences are likely to be clinically meaningful.
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  #41  
Old 29th August 2014, 06:20 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

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The immediate effects of foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in individuals with patellofemoral pain
Simon Lack, Christian Barton, Roger Woledge, Markus Laupheimer, Dylan Morrissey
Clinical Biomechanics; Articles in Press
Here is my spin on this study:
http://www.runresearchjunkie.com/foo...ofemoral-pain/
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  #42  
Old 13th February 2015, 08:25 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

The Influence of Foot Orthoses on Patellofemoral Pain Syndrome: A Systematic Analysis of the Literature.
Ahlhelm A, Alfuth M.
Sportverletz Sportschaden. 2015 Feb 12.
Quote:
Background: The patellofemoral pain syndrome (PFPS) is one of the most commonly encountered disorders involving the knee. The symptoms often lead to a reduction of physical activities resulting in sport- and job-related disabilities and the potential occurrence of severe disorders. Different theories for the development of the syndrome exist which result in different therapy modalities. A change in foot posture and its effect on lower limb kinematics seem to be one potential risk factor for the development of the syndrome. This leads to the assumption that foot orthoses might be a potential therapy device. Objectives: The aims of this study were to outline the state of evidence for the treatment of PFPS with foot orthoses and to identify the effect of foot orthoses on PFPS. Study Design: A systematic review of clinical (CT) and randomized controlled trials (RCT) was undertaken. Methods: A systematic search for studies (CT, RCT) was conducted using the databases of Medline (PubMed), Cochrane library, and PEDro. The relevance for further analysis of studies was reviewed on the basis of title and abstract. An additional search was undertaken using the reference lists of the included studies and additional literature as well as the PubMed function "related articles". Results: 11 studies were included in this analysis. The effect of different types of foot orthoses on pain, function and kinematics of the lower limb and muscle activation of selected lower limb muscles was analysed. Significant effects on pain and function were determined. A slight effect on kinematics of the lower limb and muscle activation of selected lower limb muscles was identified. Conclusion: Foot orthoses seem to be an effective treatment device in the therapy for PFPS. An immediate and long-term reduction in pain and an improvement of function occurred following the intervention. There was just a slight change in lower limb kinematics and muscle activation of selected lower limb muscles. The relationship between biomechanical effects of orthoses and pain still seems to be unclear.
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  #43  
Old 23rd May 2015, 08:25 AM
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Default Re: Foot orthoses and patellofemoral pain syndrome

Effects of a functional foot orthosis on the knee angle in the sagittal plane of college students in their 20s with flatfoot.
Park K Seo K2
J Phys Ther Sci. 2015 Apr;27(4):1211-3
Quote:
[Purpose] The purpose of this study was to examine the effects of a functional foot orthosis on the knee angle in the sagittal plane of college students in their 20s who had flatfoot.
[Subjects and Methods] The subjects of this study were 20 college students diagnosed as having flatfoot. The variations of their knee angle (Q-angle) in the sagittal plane during the stance phase were measured using the VICON Motion System (Vicon, Hansung, Korea) before and while wearing a foot orthosis. The experimental data were analyzed using SPSS 12.0 for Windows.
[Results] The Q-angle in the test group during the stance phase showed statistically significant declines on the right and left sides while wearing the foot orthosis during the gait-phases of loading response and midstance. During initial contact, terminal stance, and preswing, the Q-angle also decreased on the right and left sides after wearing the foot orthosis, but the changes were not statistically significant.
[Conclusion] The college students with flatfoot exhibited declines in the Q-angle in the sagittal plane while wearing a foot orthosis. In this regard, the application of active gait training using orthotic shoes for long hours is likely to help individuals with flatfoot to achieve normal gait.
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  #44  
Old 17th June 2015, 03:35 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

From May LER:
Foot orthoses and patellofemoral pain: frontal plane effects during running
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  #45  
Old 30th June 2015, 01:48 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

Effects of foot orthoses on patellofemoral load in recreational runners
Sinclair J, Vincent H, Selfe J, Atkins S, Taylor PJ, and Richards J
The Foot and Ankle Online Journal 8 (2): 5
Quote:
The most common chronic injury in recreational runners is patellofemoral pain. Whilst there is evidence to suggest that orthotic intervention may reduce symptoms in runners who experience patellofemoral pain the mechanism by which their clinical effects are mediated is currently poorly understood. The aim of the current investigation was to determine whether foot orthoses reduce the loads experienced by the patellofemoral joint during running. Patellofemoral loads were obtained from fifteen male runners who ran at 4.0 m·s-1. Patellofemoral loads with and without orthotics were contrasted using paired t-tests. The results showed that patellofemoral joint loads were significantly reduced as a function of running with the orthotic device. The current investigation indicates that through reductions in patellofemoral loads, foot orthoses may serve to reduce the incidence of chronic running injuries at this joint.
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Old 21st July 2015, 01:34 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

THE ADDITIONAL EFFECT ORTHOTICS ON PAIN AND
FUNCTION ON PATIENTS WITH PATELLOFEMORAL
PAIN SYNDROME WHO ARE PARTICIPATING IN
PHYSICAL THERAPY
Owen Michael Johnston; May 2015
Source
Quote:
Background: PFPS is a chronic debilitating disorder affecting up to 25%
of the general population. It affects young women at a higher rate than males and
highly active individuals more than the sedentary. Previous research has been
conducted comparing 2 treatments for PFPS in terms of pain and function: custom
made orthotics (CMO) and PT as well as prefabricated orthotics and PT. Until
now, now systematic review or meta-analysis exists comparing the 2 treatment
options. The primary objective of this study is to perform a systematic review
(where possible) of the evidence for physical therapies and orthotics in the
treatment of PFPS.
Methods: A search strategy was devised for eligible studies using the
following databases: Medline, PEDro, CINAHL, and Cochrane. Search terms
included custom, prefabricated, over-the-counter, orthotics, orthosis, ortheses,
PFPS, retro patellar pain, and anterior knee pain. Reference lists of inclusive
studies were searched secondarily. Two studies were identified as suitable and
were assessed for quality and risk of bias using the PEDro scale. Effect size
calculation and meta-analysis were based on a fixed effect model.
Results: Meta-analysis identified moderate effects favoring physical
therapy and CMO (pain VAS: standardized mean difference 0.46, 95% confidence
interval 0.04 to 0.88), and a moderate effect favoring OTC over no treatment
(VAS: -0.34, -0.97 to 0.28). Although there were meaningful effects, a Q variance
of 7.34 with a p-value of 0.025 demonstrates heterogeneity. A meta-analysis was
unable to be conducted in reference to function due to the differences in outcome
measures across studies.
Conclusion: No conclusive statement can be made for the use of orthotics
in lieu of PT due to the heterogeneity of the data. More high quality clinical trials
required testing the efficacy of the use of orthotics as an additional treatment to PT
interventions. Clinicians advised to continue to use their clinical judgment to
create a proper plan of care for patients with patellofemoral pain.
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Old 5th August 2015, 07:47 PM
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Default Re: Foot orthoses and patellofemoral pain syndrome

Altering Knee Abduction Angular Impulse Using Wedged Insoles for Treatment of Patellofemoral Pain in Runners: A Six-Week Randomized Controlled Trial
Ryan T. Lewinson , J. Preston Wiley, R. Neil Humble, Jay T. Worobets, Darren J. Stefanyshyn
PLoS ONE 10(7): e0134461. doi:10.1371/journal.pone.0134461
Quote:
Objective
Determine if a change in internal knee abduction angular impulse (KAAI) is related to pain reduction for runners with patellofemoral pain (PFP) by comparing lateral and medial wedge insole interventions, and increased KAAI and decreased KAAI groups.

Design
Randomized controlled clinical trial (ClinicalTrials.gov ID# NCT01332110).

Setting
Biomechanics laboratory and community.

Patients
Thirty-six runners with physician-diagnosed PFP enrolled in the trial, and 27 were analyzed.

Interventions
Runners with PFP were randomly assigned to either an experimental 3 mm lateral wedge or control 6 mm medial wedge group. Participants completed a biomechanical gait analysis to quantify KAAIs with their assigned insole, and then used their assigned insole for six-weeks during their regular runs. Usual pain during running was measured at baseline and at six-week follow-up using a visual analog scale. Statistical tests were performed to identify differences between wedge types, differences between biomechanical response types (i.e. increase or decrease KAAI), as well as predictors of pain reduction.

Main Outcome Measures
Percent change in KAAI relative to neutral, and % change in pain over six weeks.

Results
Clinically meaningful reductions in pain (>33%) were measured for both footwear groups; however, no significant differences between footwear groups were found (p = 0.697). When participants were regrouped based on KAAI change (i.e., increase or decrease), again, no significant differences in pain reduction were noted (p = 0.146). Interestingly, when evaluating absolute change in KAAI, a significant relationship between absolute % change in KAAI and % pain reduction was observed (R2 = 0.21; p = 0.030), after adjusting for baseline pain levels.

Conclusion
The greater the absolute % change in KAAI during running, the greater the % reduction in pain over six weeks, regardless of wedge type, and whether KAAIs increased or decreased. Lateral and medial wedge insoles were similar in effectiveness for treatment of PFP.

Clinical Relevance
Altering KAAI should be a focus of future PFP research. Lateral wedges should be studied further as an alternative therapy to medial wedges for management of PFP.
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