Foot Orthoses for Treatment of Patellofemoral Joint Pain
Foot orthoses are custom-designed devices used in treating patellofemoral joint pain by correcting foot posture and improving lower limb biomechanics. They are prescribed as part of conservative management to reduce pain during activities like walking, running, and squatting. Physiotherapists often recommend foot orthoses to decrease functional impairments and prevent the development of chronic conditions like osteoarthritis. The prevalence of patellofemoral joint pain is high, making orthotics an essential tool in managing this condition.
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FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Isaac Knott Student ID: u3068884
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
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/
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) .
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
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
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Evaluation Strengths Weaknesses 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. Only two articles were examined Prevented assessments of heterogeneity and sensitivity Neither of the reviewed trials had a clearly defined control group.
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Evaluation Strengths Weaknesses Systematic review did include some RCT s Larger number of studies and participants 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
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Evaluation Strengths Weaknesses Clearly defined control Low participant numbers Clear conclusion drawn Shorter duration (6wks) Well-designed methods that attempted to limit possible sources of bias (e.g. Blinding) Orthoses supplied by prominent international manufacturer. Bias?
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.
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.
FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Thank you! Any Questions ? Email: Zacknott@gmail.com
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
