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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.
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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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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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