Effects of foot orthoses on quality of life for individuals with patellofemoral pain syndrome

STUDY DESIGN: Repeated-measures analysis of intervention. OBJECTIVES: To determine the effects of foot orthoses on quality of life for individuals with patellofemoral pain who demonstrate excessive foot pronation. BACKGROUND: Foot orthoses are a common intervention for patients with patellofemoral pain. Limited information is available, however, regarding the effects of foot orthoses on quality of life for these patients. METHODS AND MEASURES: Sixteen subjects with patellofemoral pain who also exhibited signs of excessive foot pronation were studied. Subjects underwent a 2-week period of baseline study followed by custom foot orthotic intervention. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was administered to subjects at the time of screening, just prior to foot orthotic intervention, and at 2 weeks and 3 months following foot orthotic intervention. RESULTS: Wilcoxon matched-pairs signed-rank test results indicated statistically significant improvements in the pain and stiffness subscales 2 weeks following the start of foot orthotic intervention. All WOMAC subscale scores were significantly improved at 3 months compared with preintervention measurements. CONCLUSIONS: Custom-fitted foot orthoses may improve patellofemoral pain symptoms for patients who demonstrate excessive foot pronation.     

Outcome of orthoses intervention in the rheumatoid foot

This study was carried out to determine the effect of foot orthoses on pain, gait, and energy expenditure in patients with rheumatoid arthritis. Eighteen patients were evaluated for these parameters. Each patient was given a foot insert or shoe modification suitable for his or her foot deformity. Following 3 months of orthosis use, a significant difference was found in regards to pain (p < .05), step length and stride length (p < .05), and physiological cost index (p < .05). The results suggest that foot orthoses are an important feature in the rehabilitation of the rheumatoid foot.     

The role of articular cartilage in patellofemoral pain

This article describes a conservative program of treatment for patellofemoral pain of chondromalacic origin. It has become obvious that patellofemoral pain syndromes are derived from cartilage degradation and from soft-tissue changes, including tendinitis and neuromatous degeneration.     

Custom foot orthoses for running.

This article reviews the epidemiology of running injuries, the rationale and application of custom foot orthoses for running, and the design and material choices for fabrication in one laboratory. In an age of evidence-based medicine, much research must be done to look further at foot orthotic efficacy and how these devices contribute to an injury management plan. When designing custom foot orthoses for running, the differences between walking and running mechanics must be considered. Choices of the foot care specialist depend on patient body habitus, foot type, biomechanical scenario, and desired functional performance expectations.     

Adolescent patellofemoral pain: implicating the medial patellofemoral ligament as the main pain generator

Purpose  The purpose of this study is to define the clinical presentation of adolescent patellofemoral pain. Methods  A review was completed of all patients with patellofemoral pain at a children’s hospital sports clinic over a 3-year period. Results  One hundred and one patients (91 female) with 136 symptomatic knees were identified. Mean age was 14.4 years. Knee pain was localized to the anteromedial or anterior region of the knee in 96% of patients and was typically produced with running (94%), jumping (92%) and stair use (69%). On physical examination there was usually a non antalgic gait (99%), no patellofemoral crepitation (98%), normal lower extremity angular (84%) and rotational alignment (94%), with no foot malalignment (>97%). The medial patellofemoral ligament (MPFL) was the most palpably tender area of the knee in 98% of patients. During “lateral apprehension” testing, 89% had pain at the MPFL, but not true apprehension. A “J-sign” was present at terminal knee extension in 65%. Mean Q-angle was 18.7°. Means of all radiographic measures were within normal ranges. Conclusion  The prototypical patient had anterior/anteromedial knee pain of insidious onset during running and jumping. The most consistent physical findings were focal tenderness at the MPFL, positive terminal J-sign, and an elevated Q-angle. Most patients required only nonsurgical treatments, but 18% underwent surgical interventions for persistent pain.     

Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

Background  

Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy.     

Hyperbaric oxygen as an intervention for managing wound hypoxia: its role and usefulness in diabetic foot wounds

Few topics in diabetic wound management generate as much "heated" discussion as hyperbaric oxygen (HBO). Hyperbaric oxygen is an intermittent inhalation therapy in which the patient breathes oxygen at greater than 1 atm of pressure. This requires placement of the patient into a sealed vessel (chamber) which is capable of withstanding pressurization. This article discusses the role of HBO as an adjunct to the management of diabetic problem foot wounds from evidenced-based, approved (by Medicare) indications and cost-effectiveness perspectives.     

Prostheses and orthoses for the foot and ankle

The general nature and function of the AFO has been presented. These devices encompass the foot and leg crossing the ankle joint. They may insert into the shoe or attach to the shoe. The more recent AFOs are made of polypropylene and were formerly composed of steel. The indications for an AFO are for a basically ambulatory patient with problems walking, including various pathologic gaits especially drop-foot and spastic equinus. Other primary indications include ankle arthritis, Charcot foot, fractures, and post-surgery. Given the basic employment of AFOs to treat problems directly related to the foot, it is hoped that this introduction has stimulated practitioners to begin using this essential tool as an integral component of their practice.     

Prefabricated foot orthoses compared to a placebo intervention for the treatment of chronic nonspecific low back pain: a study protocol for a randomised controlled trial

Background

Prefabricated foot orthoses are used to treat chronic nonspecific low back pain, however their effectiveness and potential mechanism of action is unclear. The primary aims of the study are to investigate the effectiveness of prefabricated foot orthotic devices for reducing pain and improving function in people with chronic nonspecific low back pain over 52 weeks.

Methods

This study is a participant and assessor blinded, parallel-group, superiority randomised (1:1) controlled trial. The study will recruit 60 participants aged 18 to 65 years with chronic nonspecific low back pain. Participants will undergo randomisation to a control group (The Back Book) or an intervention group (prefabricated foot orthoses and The Back Book). The primary outcome measures will be change in pain and function from baseline to 12 (primary time point), 26, and 52 weeks. Secondary outcome measures include: gluteus medius muscle activity and transversus abdominis muscle thickness from baseline to 12 weeks, physical activity over 12, 26, and 52 weeks, and correlation between foot type and change in measures of pain and function. Number of hours per day and week that the prefabricated orthoses are worn, as well as, adverse events will be self-reported by participants. Data will be analysed using the intention-to-treat principle.

Discussion

This trial will primarily evaluate the effectiveness of prefabricated foot orthotic devices for reducing pain and improving function in people with chronic nonspecific low back pain over 52 weeks. It is expected that this study will provide clinicians and researchers with an understanding of the role that prefabricated foot orthoses may have in the treatment of chronic nonspecific low back pain and a potential mechanism of action, and whether foot type influences the outcome.

Trial registration

ACTRN12618001298202.

     

Biomechanical effects of foot orthoses during walking

The purpose of this study was to quantify kinetic and kinematic effects during the stance phase of walking using three different foot orthoses. All test subjects were measured under five test conditions with 10 repetitions each. The test conditions included: neutral orthosis (tested twice) and three different orthoses (posting, molding and posting combined, proprioceptive). Whereas most previous studies rely on healthy subjects to describe effects of orthoses during gait, the present study used eight patients (all pes valgus). Standard gait analysis was used with force plates (KISTLER) and an optoelectric measuring system (VICON). The results show that the combined molding and posting foot orthosis significantly reduced eversion and eversion moments during walking compared to a posting type and a proprioceptive orthosis in several test parameters. EMG measurements with fine wire electrodes on three of the test subjects revealed that the activity pattern of the tibialis posterior muscle can considerably change between subjects but may not be used to explain apparent individual effects. The results suggest that for subjects with pes valgus a combined molding and posting orthoses reduces eversion best and that individual variations may be due to subject dependent proprioception, internal foot mechanics and/or a combination of both.     

The effectiveness of walking as an intervention for low back pain: a systematic review

As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low–moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP.     

Conservative care for patellofemoral pain.

Patellofemoral pain is the most common presenting complaint about the knee joint. The explanation for this pain is not entirely clear. The four schools of thought concerning the etiology are divided among explanations based on anatomy, biomechanics, and biochemistry. The treatment for the disease is compromised by the lack of a clear causative agent. Exercises, braces, activity modification, and some medications form the basic protocol for treatment. Until the etiology becomes clear, these approaches represent the only reasonable therapy.     

Health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders

This exploratory study attempted to estimate the severity of health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders in the Netherlands. Information on the severity and the distribution of the complaints in these patients is important to acquire insight in the problems which these patients experience, and moreover is essential for further research, especially for evaluating effects of patients undergoing foot orthosis treatment. Patients with degenerative foot disorders aged 18 years and over were recruited from nine orthopaedic workshops over a period of three months in 2000. One hundred and twenty-two (122) patients were included in the study. Two approaches were used to obtain data. Firstly, shoe technicians and orthotists inspected patients' feet and legs and interviewed them at their initial visit. Data on gender, age, height, weight, existing and prescribed orthotic devices were recorded on a report form. Secondly, patients were asked to fill in a questionnaire assessing type, location, frequency, intensity and duration of health complaints, and disability. Data indicate that females with degenerative foot disorders and foot orthoses are twice as common as men. Patients supplied with foot orthoses are twice as often overweight compared to subjects in the general population. Besides frequent and protracted pain there are also fatigue complaints, particularly in the feet and lower leg. Duration and frequency of the complaints suggest that these patients suffer from a chronic pain syndrome. In addition, the results indicate that the functional level of these patients is below that of the general population, in particular regarding physical activities.     

A case-series study to explore the efficacy of foot orthoses in treating first metatarsophalangeal joint pain

Background

First metatarsophalangeal (MTP) joint pain is a common foot complaint which is often considered to be a consequence of altered mechanics. Foot orthoses are often prescribed to reduce 1^st MTP joint pain with the aim of altering dorsiflexion at propulsion. This study explores changes in 1^st MTP joint pain and kinematics following the use of foot orthoses.

Methods

The effect of modified, pre-fabricated foot orthoses (X-line^®) were evaluated in thirty-two patients with 1^st MTP joint pain of mechanical origin. The primary outcome was pain measured at baseline and 24 weeks using the pain subscale of the foot function index (FFI). In a small sub-group of patients (n = 9), the relationship between pain and kinematic variables was explored with and without their orthoses, using an electromagnetic motion tracking (EMT) system.

Results

A significant reduction in pain was observed between baseline (median = 48 mm) and the 24 week endpoint (median = 14.50 mm, z = -4.88, p < 0.001). In the sub-group analysis, we found no relationship between pain reduction and 1^st MTP joint motion, and no significant differences were found between the 1^st MTP joint maximum dorsiflexion or ankle/subtalar complex maximum eversion, with and without the orthoses.

Conclusions

This observational study demonstrated a significant decrease in 1^st MTP joint pain associated with the use of foot orthoses. Change in pain was not shown to be associated with 1^st MTP joint dorsiflexion nor with altered ankle/subtalar complex eversion. Further research into the effect of foot orthoses on foot function is indicated.

     

Efficacy of foot orthoses as nonoperative treatment for hallux valgus: A 2-year follow-up study

BackgroundThe purpose of this study was to clarify the 2-year clinical and radiological outcomes of nonoperative treatment using foot orthosis for hallux valgus patients.MethodsPatients who underwent nonoperative treatment using foot orthosis were surveyed prospectively. Foot orthoses were made by one certified orthotist using the standardized method. Pain and quality of life were evaluated using subjective and objective assessment measures at 3, 6, 12, 18, and 24 months. Furthermore, radiological outcomes, patient satisfaction, and adherence to treatment were surveyed.ResultsA total of 53 patients (50 women and 3 men; median age, 63 years) were included for analysis. The pain visual analogue scale score significantly decreased over time, with the lowest score observed at 12 months. The treatment effect was maintained over 24 months (median score, 52, 21, and 27 points at baseline, 12 months, and 24 months, respectively; P < .001). The Japanese Society for Surgery of the Foot hallux scale, American Academy of Orthopaedic Surgeons Foot and Ankle Scale, and 36-Item Short-Form Health Survey bodily pain subscale also improved, although the treatment effects were maximal at 6 months and decreased thereafter. At 24 months, 43 (81%) patients continued to use the orthosis, with the median visual analogue scale score for patient satisfaction of 76 points. The hallux valgus angle and intermetatarsal angle did not change during the 24-month period.ConclusionNonoperative treatment using foot orthoses decreased pain in patients with hallux valgus. The effect of treatment was maintained up to 2 years with a relatively high degree of patient satisfaction. However, treating physicians should inform patients to set realistic expectations and be aware that a limited degree of pain reduction is expected.     

Comparison of foot pronation and lower extremity rotation in persons with and without patellofemoral pain

Abnormal foot pronation and subsequent rotation of the lower extremity has been hypothesized as being contributory to patellofemoral pain (PFP). The purpose of this study was to test the hypothesis that subjects with PFP would exhibit larger degrees of foot pronation, tibia internal rotation, and femoral internal rotation compared to individuals without PFP. Twenty-four female subjects with a diagnosis of PFP and 17 female subjects without PFP participated. Three-dimensional kinematics of the foot, tibia, and femur segments were recorded during self-selected free-walking trials using a six-camera motion analysis system (VICON). No group differences were found with respect to the magnitude and timing of peak foot pronation and tibia rotation. However, the PFP group demonstrated significantly less femur internal rotation compared the comparison group. These results do not support the hypothesis that individuals with PFP demonstrate excessive foot pronation or tibial internal rotation compared to nonpainful individuals. The finding of decreased internal rotation in the PFP group suggests that this motion may be a compensatory strategy to reduce the quadriceps angle.