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Foot Orthoses
January 11, 2010
As an alternative or adjunct to physiotherapy, foot orthoses are commonly used to treat active people with patellofemoral pain syndrome. A systematic review of the clinical efficacy of foot orthoses identified two small clinical trials in people with patellofemoral pain syndrome that suggested orthoses may be of benefit. No high quality, randomized, controlled trials have evaluated the use of foot orthoses for treating patellofemoral pain syndrome in the short or long term. The authors evaluated the short- and long-term clinical efficacy of foot orthoses in the treatment of patellofemoral pain syndrome compared with flat inserts or physiotherapy alone, and whether orthoses improved the effects of physiotherapy.
The authors carried out a single blind, randomized clinical trial in a community setting in Queensland, Australia, for 12 months. Eligibility criteria were age 18-40; insidious onset of anterior knee or retropatellar pain of over six weeks' duration and provoked by at least two of: prolonged sitting or kneeling, squatting, running, hopping, or stair walking; tenderness on palpation of the patella, or pain with step down or double leg squat; and pain over the previous week of at least 30 mm on a 100 mm visual analogue scale.
Participants were randomly assigned to prefabricated foot orthoses (fitted to their shoes), flat inserts, physiotherapy, or foot orthoses plus physiotherapy.
There were 179 participants (100 women) with a clinical diagnosis of patellofemoral pain syndrome of over six weeks’ duration, who had no previous treatment with foot orthoses or physiotherapy in the preceding 12 months.
The results showed that significant effects favored 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 (2-51) 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. At six and 12 weeks, no significant differences were found in global improvement between physiotherapy and foot orthoses, or between physiotherapy and combined physiotherapy and orthoses.
Over 52 weeks, all groups had clinically meaningful improvements of worst pain severity (>20 mm on pain visual analogue scale), anterior knee pain scale (>10 points), and functional index questionnaire (>2 points). Three of the four groups (foot orthoses, physiotherapy, foot orthoses plus physiotherapy) also had clinically meaningful improvements in usual pain severity, while the improvement in usual pain for the group receiving flat inserts was slightly less than 20 mm. No significant differences were found between groups on any primary measure at 52 weeks.
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