The Effect of Foot Orthoses on Patellofemoral Pain Syndrome (Knee Pain) - Amol Saxena, DPM* and Jack Haddad, DPM* - Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA. Corresponding author: Amol Saxena, DPM, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301. From The Lower Extremity 5(2): 95-102.
In a retrospective review of 102 patients treated for chondromalacia patellae and patellofemoral knee pain syndrome/retropatellar dysplasia (PFPS/RPD), the effectiveness of semiflexible foot orthotics was investigated. The combined disorders were diagnosed in 89.3% of the patients. Subjects were 46 women and 54 men, aged 12 to 87 years (mean, 37.9 years; SD, 15.9), who exhibited excessive forefoot varus or rearfoot varus. The initial screening and clinical diagnosis were based on an examination by an orthopedist. Particular attention was directed to patellar crepitation, patellofemoral malalignment, Q-angle measurements, limitation of range of motion, and knee effusion. Patients were evaluated for the onset and duration of patellofemoral pain and degree of knee joint disease. Semiflexible orthoses for each subject were fabricated, based on a clinical lower extremity biomechanical examination. At their follow-up visit, 76.5% were improved, showing a significant decrease in the level of pain with orthotics intervention (chi-square P < .001). Although multiple treatment modalities are used for these patients, the results suggest that the use of semiflexible orthoses is significant in reducing symptoms of PFPS/RPD. (J Am Podiatr Med Assoc 93(4): 264-271, 2003)
The Role of Foot Orthotics as an Intervention for Patellofemoral Pain (Knee Pain)
Michael T. Gross, PT, PhD1- Judy L. Foxworth, PT, MS, OCS2
Foot orthotics often are prescribed for patients with patellofemoral knee pain. The purpose of this clinical commentary is to review the theoretical and research basis that might support this intervention and to provide our own clinical experience in providing foot orthoses for these patients. Literature is reviewed regarding (1) the effects of foot orthoses on pain and function, (2) the relationship between foot and lower-extremity/patellofemoral joint mechanics, (3) the effects of foot orthoses on lower-extremity mechanics, and (4) the effects of foot orthoses on patellofemoral joint position. The literature and our own clinical experience suggest that patients with patellofemoral pain may benefit from foot orthoses if they also demonstrate signs of excessive foot pronation and/or a lower-extremity alignment profile that includes excessive lower-extremity internal rotation during weight bearing and increased Q angle. The mechanism for foot orthoses having a positive effect on pain and function for these patients may include (1) a reduction in internal rotation of the lower extremity; (2) a reduction in Q angle; (3) reduced laterally-directed soft tissue forces from the patellar tendon, the quadriceps tendon, and the iliotibial band; and (4) reduced patellofemoral contact pressures and altered patellofemoral contact pressure mapping. Foot orthotics may be a valuable adjunct to other intervention strategies for patients who present with the previously stated structural alignment profile. J Orthop Phys Ther 2003;33:661-670.
Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia 4072
Foot orthoses produced improvement beyond that of flat inserts in the short term, notably at six weeks (relative risk reduction 0.66, 99% confidence interval 0.05 to 1.17; NNT 4 (99% confidence interval 2 to 51). Significant effects favoured foot orthoses over flat inserts at six weeks, with differences of 19.8 mm (99% confidence interval 4.0 to 35.6) on the continuous scale of global improvement, a number needed to treat of 4 (2 to 51) on the categorical scale (success equating marked and moderate improvement), and success rates of 85% (35/41) for foot orthoses and 58% (23/40) for flat inserts. Given the long term improvement observed in all treatment groups, general practitioners may seek to hasten recovery by prescribing prefabricated orthoses. |
It is quite common for children and adolescents to complain of knee pain, especially if they are very active, play sports etc. Knee pain in children is caused by condition called Osgood-Schlatter Disease and it is part of the growing process. It causes swelling, pain and tenderness just below the knee and in some cases over the shin bone (the tibia). Osgood-Schlatter disease commonly affects boys more than girls and usually occurs immediately after a major growth spurt during pre-teen and teenage years.
During activities that involve a lot of running, jumping and bending — such as rugby, soccer, basketball, netball etc the thigh muscles (quadriceps) pull on the patellar tendons that connects the knee cap to the shin bone, causing pain an swelling in the knee area. Osgood-Schlatter usually dissapears with time. When your child stops growing, the pain and swelling should go away because the patellar tendons have become much stronger. Very rarely does Osgood-Schlatter Disease continue beyond the growing stage.
How should Osgood-Schlatter disease be treated?
First of all your child needs to cut down on time spent playing sports for 4 to 6 weeks, until the pain diminishes. Your child may also need to run at a slower speed or for a shorter amount of time and jump less often. For short-term relief you can apply an ice pack to help prevent swelling and relieve pain. Your physiotherapist may suggest that your child wear a knee brace to help the tension on the patellar tendons and quadriceps. It may take several weeks or months for the pain to completely go away.
If your child displays over-pronation of the feet (low or flat arch & rolling inward of the ankles) wearing orthotics inside the shoes are recommended, especially during sports and running. If quadriceps and/or hamstring tightness is present it should be addressed with stretching exercises.
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| Many studies have proven that strenthening of the quadriceps can be very beneficial in the treatment and prevention of knee pain. Also more flexible quadriceps will help you, as tight leg muscles can pull the patella out of line. Your muscles don’t work alone and if one group of muscles is particularly tight it won’t be long before the rest follows! Therefore stretching exercises are as important as strenghtening exercises. The quadriceps are one of the largest muscle groups in the body. The quadriceps muscles begin at our knee and run all the way up our thigh into our pelvis. Below are a number of simple exercises which can be done at home.
Strengthening Exercise 1: Leg lift
This is an easy exercise for beginners. Sit on the edge of a chair. Place your hands on the sides of the chair. With your legs at a 90-degree angle and your feet flat on the floor, slowly lift one leg up until it's completely straight. You'll feel your thigh muscles tighten once the knee is straight. Hold this position for about 10-15 seconds. Make sure your movements are slow for the best results. Let your leg go and place your foot back on the floor. Now do the same with your other leg. Make sure that you sit far enough into the chair so that it won't tip over while you do these exercises and fall off the chair. Do this exercise in both legs at least 10 times, so 20 times in total.
Strengthening Exercise 2: Squats
Stand up straight and place your feet hip-width apart. Put your arms straight out in front of you. Very slowly bend your knees and lower your body to a 90-degree angle from your knees. If you're not able to lower yourself to a 90-degree angle, just go as low as you can without straining yourself. As your quadriceps muscles get stronger, you'll be able to go a little lower every day until you can lower yourself to a 90-degree angle. While you're lowering your body, keep your upper body completely straight. Your upper body may try to bend forward, from your waist, but do your best to keep your back and waist straight and unbent. Beginners often tire after doing as few as five squats. If this happens to you, keep going. Try to gradually build your strength until you can comfortably do 15 squats.
Strengthening Exercise 3: Lunges
Lunges are another good way to strengthen the quadriceps and also your buttocks. Stand up straight. Take a big step forward, moving one foot out from your body while keeping the other foot in place as if you were walking. Simultaneously bend both knees until the leg that is in front is lowered to a 90-degree angle from your calf. Your front foot will be firmly placed on the ground, your back heel will lift from the ground. While doing the lunge, keep the rest of your body straight. Then return the outstretched leg back to your body while you return to an upright position. Repeat this exercise 15 times for both legs.
Stretching Exercise 1: Standing Quadriceps Stretch
Pick your leg up behind you whilst standing and hold your foot with your hand. Gently pull you foot in towards your bum. As you do this you should feel a strong stretch in the front of your leg. Only go as far as the point where you feel the stretch in the middle of the muscle and not at either your knee or hip. If you feel it at the either end of your upper leg then you have gone too far and must relax and take your foot away slightly until the stretch is back in felt only the middle of your upper leg. Hold this position for about one minute and then repeat the process for the other leg. Repeat this exercise 2-3 times for both legs.
Stretching Exercise 2: Kneeling Quadriceps Stretch
Place one knee on the floor and have the other leg bent with your foot flat on the floor and the knee bent at about 90 degrees. Your other leg should be beneath your body with the knee on the ground and your lower leg out behind you. Next with one hand grab the foot that is behind you and pull it towards your bum. You will find that it gets tight much quicker than the standing one as you have already started stretching it from the hip. Importantly, you must keep your upper body completely upright with this exercise. The temptation is to lean forwards but don’t as this will completely ruin the whole point of the stretch. Hold the stretch for about 1 minute and repeat it for the other leg. Do this exercise 2-3 times for both legs.
IMPORTANT: stretching exercises should never hurt, so don't overdo it! Always take big breaths in and out while you're stretching and relax into the stretch.
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