This presentation covers and evaluates some of the literature surrounding the topic of foot orthoses for the treatment of patellofemoral pain.

1. FOOT ORTHOSES
FOR THE
TREATMENT OF
PATELLOFEMORAL
JOINT PAIN
Isaac Knott
Student ID: u3068884

2. 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

3. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
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/

4. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
“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)”.

5. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
 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

6. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
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

7. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN

8. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN

9. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN

10. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Evaluation
Strengths
 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.

11. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN

12. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN

13. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Evaluation
Strengths
 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

14. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN

15. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN

16. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Evaluation
Strengths
 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?

17. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
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.

18. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
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.

19. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Thank you!
Any Questions ?
Email: Zacknott@gmail.com

20. FOOT ORTHOSES FOR THE
TREATMENT OF
PATELLOFEMORAL JOINT PAIN
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