Study protocol
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Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: a randomised clinical trial
Bill Vicenzino , Natalie Collins , Kay Crossley , Elaine Beller , Ross Darnell and Thomas McPoil
BMC Musculoskeletal Disorders 2008, 9:27doi:10.1186/1471-2474-9-27
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ACTRN012605000463673
ClinicalTrials.gov NCT00118521 -
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The full results of this study are eagerly awaited. A sneak peak at the results at last yrs SMA mtg showed the foot orthotic group did better than the placebo group, which is a relief in the context of:
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hi- I'm a final year pod student currently swimming in piles of journals as i write up my lit review (on mcconnell taping vs orthoses in the contol of PFPS). I'm interested in what was said about the preliminary results of the new RCT - is there anything in writing i could look at (or quote!) and when are the full details expected.
thanks
matt owen
UUJ (northern ireland) -
Nothing in writing released by researchers yet.
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Hopefully this is a case of turning anecdotal evidence into research based evidence. There are so many areas like this within orthotic therapy. Will we ever get all the bases covered? I only wish I had the research abilities to help.
I'm very keen to see the results of this study. When are the results due Craig?
Trent -
Hi folks, any news on this yet?
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:welcome:
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Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial.
Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B.
BMJ. 2008 Oct 24;337:a1735. doi: 10.1136/bmj.a1735.
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Interesting to hear the results of that one. I spent a few months immersed in knee pain and orthoses literature for my dissertation.
However, it is frustrating that there is little evidence out there of casted orthoses (in a randomised trial) in treating knee pain. Its obviously easier to do studies on off-the-shelf stuff, but we need to advance our knowledge of custom FO as well.
Anyone heard of any studies in the pipeline to look at this? -
In this trial they compared the "gold standard" physiotherapy approach to an OTC orthotic. Obviously we'd like to see a similar study with custom foot orthoses (i.e. everyone gets a customised prescription, not just a casted orthotic all made from subo with a 4 deg RF post) but then everyone is really getting a different treatment - not a RCT. What's the answer???
Finally, can we assume that custom foot orthoses would do a better job for anterior knee pain than OTC orthotics? Also, I'd like to see a cost-benefit analysis done - if foot orthoses do as good as physio, can we do it cheaper? -
There has been an interesting, informative and educational exchange on this study in the BMJ:
In the same edition as the original study was this editorial:
Editorial
Patellofemoral pain syndrome
Usually resolves over time, and intervention offers only limited benefit
C Niek van Dijk and Willem M van der Tempel
BMJ 2008; 337: a1948
This was the response from the authors:
Patellofemoral Pain Syndrome: Important Considerations -
The above al probably needs to be read in the context of the thread we had on:
Foot pronation and knee pain -
I just love the researchers that use this line as a defense for not treating pathologies. What do you tell the 16 year old female runner that develops patellofemoral pain syndrome while eagerly training with her cross-country team and desires to continue her training and improve her times? Sorry Sally, none of the treatments are 100% and your pain will resolve over time (yeah, once you stop running it will resolve and will come back again once you start running!!):bang::bang::bang:
Sounds to me like another excuse for governmments with socialized medicine and health maintenance organizations to have a reason to not treat pathologies that are easily treatable by experienced and skilled clinicians. -
This approach would not make good business sense- not because you don't treat them and therefore don't charge them, but because you wouldn't get much in the way of 'word of mouth' referalls. Patient satisfaction would be pretty poor.
They come to you because they are in pain and want help....
I don't think that I would be visiting either C Niek van Dijk or Willem M van der Tempel if I had PFJ pain...
With respect to the study- I am somewhat surprised that there was no apparent combined effect with Physio and the OTC orthos. I feel these are usually very complementry.Last edited: Nov 2, 2008 -
The Efficacy of Foot Orthoses in the Treatment of Individuals with Patellofemoral Pain Syndrome: A Systematic Review
Barton, Christian J.; Munteanu, Shannon E.; Menz, Hylton B.; Crossley, Kay M.
Sports Medicine: 1 May 2010 - Volume 40 - Issue 5 - pp 377-395
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Dave -
The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome
C J Barton, H B Menz, K M Crossley
Br J Sports Med doi:10.1136/bjsm.2009.069203
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Foot orthoses for patellofemoral pain in adults.
Hossain M, Alexander P, Burls A, Jobanputra P.
Cochrane Database Syst Rev. 2011 Jan 19;1:CD008402.
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Sloppy title (no mention of which specific foot orthoses used) - I'm pleased I didn't bother to read this one.
If researchers can't even bother to give an accurate title why would I think that the research (carried out mostly by Physio's) is going to be impartial? -
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
Kathryn Mills, Peter Blanch, Priya Dev, Michael Martin, Bill Vicenzino
Br J Sports Med doi:10.1136/bjsports-2011-090204
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I hope that these gentlemen-
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Comfort and midfoot mobility rather than orthosis hardness or contouring influence their immediate effects on lower limb function in patients with anterior knee pain.
Mills K, Blanch P, Vicenzino B.
Clin Biomech (Bristol, Avon). 2011 Sep 14
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Effects of prefabricated foot orthoses on pain and function in individuals with patellofemoral pain syndrome: a cohort study.
Barton CJ, Menz HB, Crossley KM
Phys Ther Sport. 2011 May;12(2):70-5
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Benefits of custom-made foot orthoses in treating patellofemoral pain.
Munuera PV, Mazoteras-Pardo R.
Prosthet Orthot Int. 2011 Sep 26. [Epub ahead of print]
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With orthoses being one of the modalities of treatment in this study I have to ask, which orthoses? Is there such thing as a conventional orthosis? If yes and results indicate that intervention with so called "conventional orthoses" yield better outcomes relative to other modalities, a secondary study to compare various orthotic configurations generated from a variety of prescription workup techniques could be very useful in determining which of the orthotic modalities work best.
With a proliferation of technologies / materials / services available to clinicians it might help to unclutter the decision process by pointing to those combinations that work best. -
That was the exact point I tried to make in this rant:
The Redundancy of Research on Custom Made vs Prefabricated Foot Orthotics -
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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.
Mills K, Blanch P, Dev P, Martin M, Vicenzino B.
Br J Sports Med. 2012 Mar;46(4):247-52
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Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females with and without Patellofemoral Pain Syndrome.
Boldt AR, Willson JD, Barrios JA, Kernozek TW.
J Appl Biomech. 2012 Jul 5.
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Medially posted insoles consistently influence foot pronation in runners with and without anterior knee pain
Pedro Rodrigues, Ryan Chang, Trampas TenBroek, Joseph Hamill
Gait and Posture (in press)
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Effects of medially wedged foot orthoses on knee and hip joint running mechanics in females with and without patellofemoral pain syndrome.
Boldt AR, Willson JD, Barrios JA, Kernozek TW.
J Appl Biomech. 2013 Feb;29(1):68-77.
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The effects of three quarter and full length foot orthoses on patellofemoral pain sufferers when walking and descending stairs
Jim Richards, John Burston and James Selfe
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A70 doi:10.1186/1757-1146-7-S1-A70
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Masters thesis from 2000:
THE EFFECTIVENESS OF USING FOOT ORTHOTICS AS THE SOLE
INTERVENTION FOR THE TREATMENT OF PATELLOFEMORAL PAIN
SYNDROME
Byron Horner; Grand Valley State University
Source
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No control group. Stabilizer orthotic with only 2 degrees of varus posting. Small sample size and small length of follow up. Was he just pandering to someone at his PT school who really think orthotics don't help?
Why do we keep testing OTC devices expecting different outcomes tha previously tested?
This is poor science.
Bruce -
The immediate effects of foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in individuals with patellofemoral pain
Simon Lack, Christian Barton, Roger Woledge, Markus Laupheimer, Dylan Morrissey
Clinical Biomechanics; Articles in Press
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