Lateral wedging for patellofemoral pain syndrome?

NewsBot · Oct 28, 2012

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The Effects of Wedged Footwear on Lower Limb Frontal-Plane Biomechanics During Running
Lewinson, Ryan T.; Fukuchi, Claudiane A., PT; Worobets, Jay T.; Stefanyshyn, Darren J.
Clinical Journal of Sport Medicine: 25 October 2012

Objective: Patellofemoral pain syndrome (PFPS), the most common running injury, has been associated with increased internal knee abduction angular impulses (KAAI). Wedged footwear can reduce these impulses during walking, but their effects during running are not well understood. The purpose of this study was to identify the effects of wedged footwear on KAAIs and describe the mechanism by which wedged footwear alters KAAIs during running.

Design: Controlled Laboratory Study.

Setting: Motion analysis laboratory.

Participants: Nine healthy male subjects.

Interventions: Participants ran at a speed of 4 m/s with 7 different footwear conditions (3-, 6-, and 9-mm lateral wedges; 3-, 6-, and 9-mm medial wedges; neutral).

Main Outcome Measures: Knee abduction angular impulses and 8 predictor variables were measured and compared by 1-way repeated-measures analysis of variance ([alpha] = 0.05) with Bonferroni-adjusted 2-tailed paired t tests for post hoc analysis ([alpha] = 0.002). Correlation ([alpha] = 0.05) was used to determine the relationship between the mediolateral center-of-pressure to ankle joint center (COP-AJC) lever arm length and KAAIs.

Results: Laterally wedged conditions produced significantly lower KAAIs (P = 0.001) than medial wedge conditions. Peak knee abduction moments decreased (P = 0.001), whereas ankle inversion moments (P = 0.041) and the COP-AJC lever arms increased (P < 0.001) as wedges progressed from medial to lateral. KAAIs were negatively correlated with COP-AJC lever arm length (r = -0.50, P < 0.001).

Conclusions: KAAIs are reduced with laterally wedged footwear because of lateral shifts in the center-of-pressure beneath the foot, which then increases ankle inversion moments and decreases peak knee abduction moments. Laterally wedged footwear may therefore offer greater relief to runners with PFPS than medially wedged footwear by reducing KAAIs.
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Griff · Oct 28, 2012

Conclusions: Laterally wedged footwear may therefore offer greater relief to runners with PFPS than medially wedged footwear by reducing KAAIs.
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Bit of a big shout when you consider this study looked at just 9 individuals, none of whom actually had patellofemoral pain...

Admin2 · Oct 28, 2012

Related threads:
Other threads tagged with knee, lateral wedging, patellofemoral pain, proximal problems
Lateral foot wedging for medial knee OA
Foot orthoses and patellofemoral pain syndrome

Craig Payne · Oct 28, 2012

Ian G said: ↑

Bit of a big shout when you consider this study looked at just 9 individuals, none of whom actually had patellofemoral pain...
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Darren did previously link high knee abduction impulses to patellofemoral pain in a chicken or egg study:

Knee Angular Impulse as a Predictor of Patellofemoral Pain in Runners
Darren J. Stefanyshyn, Pro Stergiou, Victor M. Y. Lun, Willem H. Meeuwisse, and Jay T. Worobets
Am J Sports Med November 2006 vol. 34 no. 11 1844-1851

Background: Identification of mechanical factors associated with patellofemoral pain, the most prevalent running injury, is necessary to help in injury prevention, but unfortunately they remain elusive.

Hypothesis: Runners who develop patellofemoral pain have increased knee joint angular impulse in the frontal plane.

Study Design: Case control study; Level of evidence, 3.

Methods: A retrospective study compared knee abduction impulses of 20 patellofemoral pain patients with those of 20 asymptomatic patients. A second prospective study quantified knee angular impulses during the stance phase of running of 80 runners at the beginning of the summer running season. Epidemiologic data were then collected, recording the type and severity of injury of these runners during a 6-month running period.

Results: The patellofemoral pain patients in the retrospective study had significantly higher (P = .026) knee abduction impulses (17.0 ± 8.5 Nms) than did the asymptomatic patients (12.5 ± 5.5 Nms). Six patients developed patellofemoral pain during the prospective study. The prospective data showed that patients who developed patellofemoral pain had significantly higher (P = .042) knee abduction impulses (9.2 ± 3.7 Nms) than did matched patients who remained uninjured (4.7 ± 3.5 Nms).

Conclusion: The data indicate that increased knee abduction impulses should be deemed risk factors that play a role in the development of patellofemoral pain in runners.
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NewsBot · Jan 25, 2021

The influence of design variations in footwear medial-lateral support on the running biomechanics of older female runners
Kim Lilley, Victoria Stiles, Sharon Dixon
Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology January 14, 2021

Reports of greater incidence of knee pain and injury in older female runners compared with their younger counterparts may be associated with differences in lower limb biomechanics that influence knee joint loading. The aim of this study was to investigate footwear interventions aimed at influencing lower limb biomechanics in older female runners (>45 years). Strategies for reducing peak rearfoot eversion and the external knee adductor moment were investigated, since both measures have been associated with knee joint injury. Twenty female runners (mean age 50.7 ± 5.6 years) performed 10 running trials in four footwear conditions: neutral running shoe (Control); neutral shoe with 4° medial heel wedge insole (Medial Wedge); neutral shoe with 4° lateral heel wedge insole (Lateral Wedge); and neutral shoe with combined insole with 5° lateral wedge and medial arch support (Combined Insole). Peak rearfoot eversion and knee external adductor moment were compared for the four conditions using RMANOVA and post-hoc Tukey tests (p < 0.05). Compared with the Control, peak rearfoot eversion was lower for the Combined Insole condition, with this value being lower than for all other insole conditions (p < 0.05). Compared with the Control, the peak knee external adductor moment was lower for the Lateral Wedge and the Combined Insole conditions (p < 0.05). These results support the use of a combined insole with lateral wedge and medial arch support for the reduction of peak rearfoot eversion and peak knee external adductor moment, variables that have been associated with increased risk of knee injury. If aiming to reduce knee external adductor moment alone, then the lateral wedge technology employed in this study provides an effective method for older female runners.
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