Predicting if foot orthoses will help in patellofemoral pain

NewsBot · Sep 30, 2008

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A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination.
Vicenzino B, Collins N, Cleland J, McPoil T.
Br J Sports Med. 2008 Sep 26. [Epub ahead of print]

Objective To develop a clinical prediction rule to identify patients with patellofemoral pain (PFP) who are more likely to benefit from foot orthoses.

Design Post-hoc analysis of one treatment arm of a randomised clinical trial. Setting Single centre trial in a community setting in Brisbane, Australia.

Participants 42 participants (mean age 27.9 years) with a clinical diagnosis of PFP (median duration 36 months). Interventions Foot orthoses fitted by a physiotherapist. Main outcome measures Five-point global improvement scale at 12-week follow-up, dichotomised with marked improvement equalling success.

Results Potential predictor variables identified by univariate analyses were age, height, pain severity, Anterior Knee Pain Scale score, Functional Index Questionnaire score, foot morphometry (arch height ratio, mid foot width difference from non-weight bearing to weight bearing), and overall orthoses comfort. Parsimonious fitting of these variables to a model that explained success with orthoses identified the following: age (> 25 years), height (< 165 centimetres), worst pain visual analogue scale (< 53.25 millimetres) and a difference in mid-foot width from non-weight bearing to weight bearing (> 10.96 millimetres). The pre-test success rate of 40% increased to 86% if the patient exhibited three of these variables (positive likelihood ratio 8.8 (95% confidence interval 1.2 to 66.9)).

Conclusion Post-hoc analysis identified age, height, pain severity and mid foot morphometry as possible predictors of successful treatment of PFP with foot orthoses, thereby providing practitioners with information for prescribing foot orthoses in PFP and stimulating further research
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Admin2 · Sep 30, 2008

Related threads:
Foot pronation and knee pain
Foot orthoses and patellofemoral pain syndrome
Other patellofemoral pain syndrome threads

NewsBot · Nov 16, 2010

Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome
C J Barton. H B Menz, P Levinger, K E Webster, K M Crossley
Br J Sports Med doi:10.1136/bjsm.2010.077644

Objective There is growing evidence for the provision of foot orthoses when treating individuals with patellofemoral pain syndrome (PFPS), and prescription is frequently based on the assessment of foot posture/function. However, evaluation of the link between abnormal foot posture/function and foot orthoses outcomes has previously been limited to static alignment measures and has produced inconsistent findings. In this study, the ability of baseline foot kinematics associated with pronation to predict marked improvement 12 weeks following foot orthoses prescription in individuals with PFPS was evaluated.

Methods 26 individuals with PFPS were issued with prefabricated foot orthoses, and patient-reported level of improvement was documented at 12 weeks. Potential predictors of marked improvement at 12 weeks were measured during walking at baseline and included forefoot dorsiflexion and abduction, and rearfoot eversion.

Results Of the 25 participants who completed the study, seven (28%) reported marked improvement with the foot orthoses after 12 weeks. Discriminant function analysis revealed a greater peak rearfoot eversion to be the only significant independent predictor of marked improvement.

Conclusion These findings provide preliminary evidence that greater peak rearfoot eversion is predictive of marked improvement 12 weeks following prefabricated foot orthoses prescription in individuals with PFPS. Therefore, foot orthoses may be most effective in the subgroup of people with PFPS and increased dynamic foot pronation.
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NewsBot · Feb 12, 2011

Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain.
Barton CJ, Menz HB, Crossley KM.
Med Sci Sports Exerc. 2011 Feb 8. [Epub ahead of print]

PURPOSE: There is emerging evidence that foot orthoses are effective in the management of patellofemoral pain syndrome (PFPS). However, the identification of those most likely to benefit from foot orthoses has not been adequately explored. The aim of this study was to develop a preliminary clinical prediction rule to help identify individuals with PFPS who are most likely to benefit from foot orthoses.

METHODS: 60 individuals with PFPS were issued with non-customised prefabricated foot orthoses containing built-in arch supports and 4° rearfoot varus wedging. Patient-reported level of improvement was documented at 12 weeks. Potential baseline predictor variables of interest included patient demographics, pain characteristics, footwear motion control properties, foot and ankle characteristics and functional performance measures.

RESULTS: Fourteen (25%) participants reported marked improvement at 12 weeks. The number of participants with marked improvement increased to 78% if three out of the following four criteria were met; footwear motion control properties score of less than 5.0 (indicative of less supportive footwear), usual pain less than 22.0 mm, ankle dorsiflexion range of motion (knee flexed) less than 41° and reduced single leg squat pain when wearing the orthoses.

CONCLUSION: Individuals with PFPS who wear less supportive footwear, report lower levels of pain, exhibit less ankle dorsiflexion range of motion and who report an immediate reduction in pain with foot orthoses when performing a single leg squat are more likely to benefit from foot orthoses
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NewsBot · Feb 2, 2018

Predictors of clinical success in runners with patellofemoral pain: secondary analyses of a randomized clinical trial.
Jean-Francois Esculier, Laurent J. Bouyer, Blaise Dubois, Jean Leblond, Mélanie Brisson, Luc chau, Jean-Sébastien Roy
MSES; Article in Press

Objectives
To identify predictors of outcome to a rehabilitation program focused on education and management of training loads in runners with patellofemoral pain (PFP).

Design
Secondary analyses of a randomized clinical trial.

Methods
Fifty-eight runners with PFP (62% female, aged 31.2 ± 6.6 years, running 20.3 ± 5.6 km/week) were included in analyses. Following baseline collection of demographics, anthropometry, symptomatology, isometric strength, running mechanics and radiological data, runners were randomized to one of the three 8-week intervention program: 1- Education on symptoms management and training modifications; 2- Education + Exercise program; 3- Education + Gait retraining. Clinical success was defined as an increase ≥13.6% on the Knee Outcome Survey − Activities of Daily Living Scale (KOS-ADLS) at 3 months following program completion. Potential predictors were entered into logistic regression analyses.

Results
Forty-five runners (78%) were categorized as Success. Together, KOS-ADLS score (<70%), knee extension isometric strength (<70% bodyweight), presence of patellar tendinopathy (Grade >0) and level of usual pain ( > 2/10) at baseline predicted treatment outcome with 87.9% accuracy. The model provided sensitivity of 0.93 (95%C.I. 0.82-0.98), specificity of 0.69 (95%C.I. 0.42-0.87), positive likelihood ratio of 3.0 (95%C.I. 1.3-6.9), and negative likelihood ratio of 0.1 (95%C.I. 0-0.3). The best individual predictors were KOS-ADLS score and knee extension strength.

Conclusions
The combination of KOS-ADLS, knee extensors strength, patellar tendon integrity and usual pain best predicted clinical outcome of runners with PFP following an intervention that had a common education component. Further testing is needed before a clinical prediction rule can be recommended to clinicians.
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