Foot Exercise and Taping in Patients with Patellofemoral Pain and Pronated Foot

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Foot Exercise and Taping in Patients with Patellofemoral Pain and Pronated Foot
Jihyun Lee et al
Journal of Bodywork and Movement Therapies; Article in Press

 

They state that as though that is a good thing. I would have thought it would be important to establish that as being a good thing in those with patellofemoral pain before you start investigating the best methods to do it.
ie is increased AbdH activity associated with better outcomes?

 

Effect of Modified Reverse-6 Taping Procedure with Elastic Tape on Medial Longitudinal Arch in Patients with Patellofemoral Pain Syndrome
Saravanakumar M et al
International Journal of Clinical Skills

 

The effects of short foot exercise on pain, knee and foot biomechanics in patients with patellofemoral pain
P Kisacik et al
Annals of the Rheumatic Diseases 2018;77:1851-1852

 

Effects of short foot exercise with visual feedback on balance and knee joint function in subjects with flexible flatfeet
J.KimM.LeeJ.Seo
Annals of Physical and Rehabilitation Medicine; Volume 61, Supplement, July 2018, Page e169

 

Is there any additional effect of foot core training on dynamic function and balance in women with patellofemoral pain? A randomized controlled study
Pınar Kısacık, Volga Bayrakcı Tunay, Nilgün Bek & Aynur Ayşe Karaduman
Sport Sciences for Health (2023)

 

Effect of adding short foot exercise to hip and knee focused exercises in treatment of patients with patellofemoral pain syndrome: a randomized controlled trial
Abdallah Mohamed Kamel et al
J Orthop Surg Res. 2024 Apr 1;19(1):207

 

So we have a randomised, controlled, single blind trial which suggests foot strengthening can improve outcomes in patellofemoral pain syndrome suffers when used in conjunction with knee and hip exercises. Hip and knee exercises alone where significantly less successful when foot strengthening was omitted.

These findings match others highlighted by the paper:

"The results of this study come in accordance with Kısacık et al., who demonstrated that individuals with PFPS who received SFE along with hip and knee strengthening and stretching exercises experienced a greater reduction in knee pain and functional improvements compared to those who only received hip and knee exercises [24]. Similarly, Mølgaard et al., investigated the effects of adding SFE to the knee focused exercise in PFPS, and the results indicated improved knee pain following adding foot-focused exercises and foot orthoses to knee-focused exercise program [25]. This improvement may be attributed to the positive effect of SFE on correcting foot pronation, improving intrinsic muscles performance, and enhancing arch support leading to decreasing stresses on the PFJ [40, 41].

I have a strong suspicion that the mechanism highlighted recently by Welte, Rainbow et al , explains why foot strengthening is important in knee, hip, back pain. Arch recoil is required to keep the tibia in a functional position during gait . Without this, the kinetic chain is compromised bottom to top. Why would your knee not give you problems if you start to run like a baboon/chimpanzee.

Foot strengthening is really, really, easy to teach when you know how.

 

The mechanism highlighted by Welte, Rainbow et al, suggests that lack of arch recoil during gait will lead to sub optimal tibial orientation and reduced ground contact time. Is there any evidence that taking the intrinsic foot musculature out of the equation will reduce arch recoil and so affect gait?

I had a look and found a paper that shows tibial nerve block, stopping the intrinsic from making and active contribution during gait, may reduce ground contact time as reflected in an increased stride rate.

The functional importance of human foot muscles for bipedal locomotion

Dominic James Farris 1 2, Luke A Kelly 2, Andrew G Cresswell 2, Glen A Lichtwark 2
Affiliations expand

• PMID: 30655349
  
• PMCID: PMC6358692
  
• DOI: 10.1073/pnas.1812820116

Abstract

Human feet have evolved to facilitate bipedal locomotion, losing an opposable digit that grasped branches in favor of a longitudinal arch (LA) that stiffens the foot and aids bipedal gait. Passive elastic structures are credited with supporting the LA, but recent evidence suggests that plantar intrinsic muscles (PIMs) within the foot actively contribute to foot stiffness. To test the functional significance of the PIMs, we compared foot and lower limb mechanics with and without a tibial nerve block that prevented contraction of these muscles. Comparisons were made during controlled limb loading, walking, and running in healthy humans. An inability to activate the PIMs caused slightly greater compression of the LA when controlled loads were applied to the lower limb by a linear actuator. However, when greater loads were experienced during ground contact in walking and running, the stiffness of the LA was not altered by the block, indicating that the PIMs' contribution to LA stiffness is minimal, probably because of their small size. With the PIMs blocked, the distal joints of the foot could not be stiffened sufficiently to provide normal push-off against the ground during late stance. This led to an increase in stride rate and compensatory power generated by the hip musculature, but no increase in the metabolic cost of transport. The results reveal that the PIMs have a minimal effect on the stiffness of the LA when absorbing high loads, but help stiffen the distal foot to aid push-off against the ground when walking or running bipedally.

 

Examining Welte, Rainbow et al further , I believe is there is more, indirect evidence that points in the direction of poor recoil through intrinsic foot muscle deficit causing sub optimal tibial angle and problems further up the kinetic chain.

A few years ago Taddei et al found that foot strengthening reduced injuries in recreational runners by a factor of about x2.4 .

If you look at the types of injuries sustained by the control vs intervention ( strengthening) groups you can see that the big difference was in injury to structures proximal to the foot, namely the knee and hamstrings ( 8 injuries in the control group and none in the strengthening intervention group, which accounts for most of that halving of injuries). To me this suggests tibial angle through gait may a major problem in runners with weaker feet.