Benefits of custom-made foot orthoses in treating patellofemoral pain.

Munuera PV, Mazoteras-Pardo R.

Source

University of Seville, Calle Avicena, Seville, Spain. pmunuera@us.es

Abstract

BACKGROUND:

Patellofemoral pain is one of the most common disorders affecting the knee. Forefoot varus and excessive subtalar pronation can be associated with patellofemoral pain. Foot orthotics may produce an improvement in symptoms.

OBJECTIVES:

The aim of this study was to test whether patellofemoral pain is improved after four weeks of using custom-made foot orthoses.

STUDY DESIGN: Clinical trial without control group.

METHODS:

Twenty-one subjects with patellofemoral pain were given custom-made foot orthoses (2-mm thick polypropylene and 4-mm thick polyethylene foam liner of 45 shore A hardness). Patellofemoral pain was evaluated with a visual analogue scale before applying the treatment, and at two weeks and four weeks follow-up. At the two-week check-up, a forefoot varus posting was added to the orthoses.

RESULTS:

Improvements in patellofemoral pain was significant in all comparisons: initial pain with pain at the two-week check-up (P <0.001), initial pain with pain at four weeks (P <0.001), and pain at two weeks with pain at four weeks (P <0.001). The effect size was large in all comparisons.

CONCLUSION:

For the participants in this study, the custom-made foot orthoses were found to be an effective conservative treatment to reduce the symptoms of patellofemoral pain.

Effect of foot orthoses contour on pain perception in individuals with patellofemoral pain.

McPoil TG, Vicenzino B, Cornwall MW.

Source

Gait Research Laboratory, Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, USA. tmcpoil@regis.edu

Abstract

BACKGROUND:

foot orthoses have been described as a possible intervention for individuals with patellofemoral joint pain. No study has attempted to quantify the perceived comfort and support of foot orthoses when used as an intervention for patellofemoral joint pain.

METHODS:

a randomized case-control trial with crossover between contoured and flat orthoses was conducted on ten individuals with patellofemoral pain and ten healthy participants. All of the participants completed a comfort-support assessment and had in-shoe plantar pressure data collected before and after 3 weeks of wear. A 1-week washout period was used to minimize any continued treatment effect between orthotics testing. The patellofemoral pain group also completed a numeric rating scale to assess pain reduction after using each orthosis.

RESULTS:

all of the participants perceived that greater support was provided by the contoured orthoses in the heel and arch regions. Even with a 30% difference in material hardness between the two orthoses, all of the participants rated cushioning as equivalent. Six individuals in the patellofemoral pain group reported a clinically significant reduction in knee pain as a result of wearing foot orthoses.

CONCLUSIONS:

a key factor in the selection of contoured foot orthoses versus flat inserts is the amount of support that an individual perceives in the arch and heel regions. In addition, clinicians using foot orthoses as an intervention for patellofemoral pain should expect an individualistic, nonsystematic response.

Joint Bone Spine. 2008 Dec;75(6):714-20. Epub 2008 Aug 22.

Is there an evidence-based efficacy for the use of foot orthotics in knee and hip osteoarthritis? Elaboration of French clinical practice guidelines.

Gélis A, Coudeyre E, Hudry C, Pelissier J, Revel M, Rannou F.

Source

Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Caremeau, Place du Pr Debré, 30029 Nîmes, France. anthony_gelis@yahoo.fr

Abstract

OBJECTIVE:

To develop clinical practice guidelines for the use of foot orthotics (FO) in the treatment of knee and hip osteoarthritis.

METHOD:

The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic review of the literature, input from every day clinical practice and external review by a multidisciplinary expert committee, was used. The selected analysis criteria were pain, disability, medications used and X-ray evolution of osteoarthritis. The recommendations are classified according to the level of proof in Grade A, B or C according to the French National Agency for Health Accreditation and Evaluation (NAHAE).

RESULTS:

In medial knee osteoarthritis, foot pronation orthotics--when there are no contraindications--can be proposed for their symptomatic impact, especially in the decrease of NSAIDs consumption (Grade B). To this day, there is no evidence of a structural or functional impact on osteoarthritis (Grade B). Outside of this specific clinical framework, there is no validated indication for prescribing foot orthotics in the treatment of knee or hip OA (Grade C).

CONCLUSION:

It is necessary to have further randomized controlled trials to better define the indication of Foot orthotics (severity of knee OA, genu varum), test the efficacy of other orthoses such as cushioning FO. The long-term side effects, mainly on the external femorotibial compartment could also be assessed. A medical and economical assessment of FO prescriptions is also quite necessary.

Med Sci Sports Exerc. 2008 May;40(5):913-7.

The influence of arch supports on knee torques relevant to knee osteoarthritis.

Franz JR, Dicharry J, Riley PO, Jackson K, Wilder RP, Kerrigan DC.

Source

University of Virginia, Department of Physical Medicine and Rehabilitation, Charlottesville, VA 22908, USA. JRF5N@virginia.edu

Abstract

PURPOSE:

Changes in footwear and foot orthotic devices have been shown to significantly alter knee joint torques thought to be relevant to the progression if not the development of knee osteoarthritis (OA) in the medial tibiofemoral compartment. The purpose of this study was to determine if commonly prescribed arch support cushions promote a medial force bias during gait similar to medial-wedged orthotics, thereby increasing knee varus torque during both walking and running.

METHODS:

Twenty-two healthy, physically active young adults (age, 29.2 +/- 5.1 yr) were analyzed at their self-selected walking and running speeds in control shoes with and without arch support cushions. Three-dimensional motion capture data were collected in synchrony with ground reaction force (GRF) data collected from an instrumented treadmill. Peak external knee varus torque during walking and running were calculated through a full inverse dynamic model and compared.

RESULTS:

Peak knee varus torque was statistically significantly increased by 6% (0.01 +/- 0.02 N.m.(kg.m)(-1)) in late stance during walking and by 4% (0.03 +/- 0.03 N.m.(kg.m)(-1)) during running with the addition of arch support cushions.

CONCLUSIONS:

The addition of material under the medial aspect of the foot by way of a flexible arch support promotes a medial force bias during walking and running, significantly increasing knee varus torque. These findings suggest that discretion be employed with regard to the prescription of commonly available orthotic insoles like arch support cushions.