Orthotics and the treatment of patellofemoral pain
Patellofemoral pain syndrome or pain arising from the front of the knee is common in both athletes and the non-athletic population. One survey of over 2000 runners presenting to a sports medicine Centre it accounted for 19% of running injuries. It is present in as much as 25% of the general nonathletic population and although it occurs in all age groups is more common during adolescence and young adults.
Symptoms include persistent pain behind the kneecap pain aggravated by a descending and ascending stairs, squatting and prolonged sitting. It also is company often by crepitus (crunching), clicking, catching or a sensation of giving way. Swelling and warmth is rare and total movement is generally not affected. This problem can persist over several years with little change, with one study reporting that 25% of patients with patellofemoral pain had significant symptoms of 20 years later.
Many theories are being suggested regarding the cause of patellofemoral pain. These include patella malalignment, neuroms, abnormal tibial and femoral rotation, a high riding on low riding patella, excessive activity or sudden increases in activity, hip muscle weakness, and excessive pronation at the subtalar joint.
Looking at the subtalar joint and the foot it has been suggested that increased internal rotation of femur may occur due to the increased pronation at the subtalar joint. This may result in increased compression between the lateral part of the patella in the latter part of the femur. This change in alignment may cause lateral tracking of the patella. These theories suggest that a reduction of pronation may reduce patellofemoral tracking and pain by improving lower limb dynamic alignment.
As an alternative or adjunct physiotherapy for orthoses are commonly used to treat patellofemoral pain syndrome. A recently a systematic review of the clinical evidence for orthoses identified several clinical trials with patellofemoral pain syndrome. These studies suggest the full for orthoses may be benefit. Another study investigated the efficacy of foot orthotics and compared it to physiotherapy and further compared it to fit foot orthotics plus physiotherapy. The results of the study showed the foot of orthoses produced in the improvement in the short term notably six weeks. No significant differences were found between foot orthoses and physiotherapy and no additional benefit could be gained with physiotherapy treatment by adding orthotics. All groups improved meaningfully over 52 weeks. In another study subjects experienced significant decreases in symptoms of pain and stiffness and improvement in physical function following the foot orthotic. They experienced these improvements within the first two weeks and maintain significant improvement a three month follow-up assessment.
Conclusion
The evidence and clinical experience indicate that foot orthoses are useful adjuncts to the treatment of patellofemoral pain. Non-orthotic interventions such as physiotherapy are probably equally valuable and the patient with patellofemoral pain should be given the option of orthotics, as they have potential to lessen the need for ongoing exercise, and may provide more immediate relief of symptoms.
Johnston, L. Gross, T. Effects of foot orthoses on quality of life for individuals withpatellofemoral pain syndrome. Journal of Orthopaedic and Sports Physical Therapy 2004
Collins N, Bisset L, McPiol T, Vincenzo B. Foot Orthoses in lower limb overuse conditions: a systematic review and meta analysis. Goot Ankle Int 2007; 28 396 - 412
Collins, Crossley, Beller, 2008 Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ 2008;337