Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females With and Without Patellofemoral Pain Syndrome

La Crosse Institute for Movement Science, Department of Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, WI.
Journal of applied biomechanics (Impact Factor: 0.98). 02/2013; 29(1):68-77.
Source: PubMed


We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

Download full-text


Available from: Thomas W Kernozek
  • Source
    • "Increased rear-foot eversion and pes pronatus can favour internal rotation and thus a dynamic valgus position of the lower extremity [3–5, 11, 44]. Therefore, insoles or foot orthotics could be a treatment option to correct the malalignment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment). Causes for the dynamic valgus may be decreased strength of the hip abductors or abnormal rear-foot eversion with pes pronatus valgus. PFPS is further associated with vastus medialis/vastus lateralis dysbalance, hamstring tightness or iliotibial tract tightness. The literature provides evidence for a multimodal non-operative therapy concept with short-term use of NSAIDs, short-term use of a medially directed tape and exercise programmes with the inclusion of the lower extremity, and hip and trunk muscles. There is also evidence for the use of patellar braces and foot orthosis. A randomized controlled trial has shown that arthroscopy is not the treatment of choice for treatment of PFPS without any structural changes. Patients with anterior knee pain have to be examined carefully with regard to functional causes for a PFPS. The treatment of PFPS patients is non-operative and should address the functional causes. Level of evidence V.
    Full-text · Article · Nov 2013 · Knee Surgery Sports Traumatology Arthroscopy
  • [Show abstract] [Hide abstract]
    ABSTRACT: The mechanism of action of a foot orthotic is poorly understood. The purpose of this study was to use Principal Components Analysis (PCA) to analyze the effects of a prefabricated foot orthotic on frontal plane knee and ankle mechanics during running. Thirty-one healthy subjects performed running trials with and without a foot orthotic and PCA was performed on the knee and ankle joint angles and moments to identify the dominant modes of variation. MANOVAs were conducted on the retained PCs of each waveform and dependent t-tests (P<.05) were performed in the case of significance. Mechanics of the ankle were not affected by the foot orthotic. However, mechanics of the knee were significantly altered as subjects demonstrated an increase in the magnitude of the knee abduction moment waveform in an orthotic condition. Subjects also demonstrated a significant shift in the timing of the knee abduction moment waveform towards later in the stance phase in the orthotic condition. These orthotic effects were not related to subject's foot mobility, measured using the Navicular Drop test. The mechanism of action of a foot orthotic may be related to their effect on the timing of frontal plane knee loading.
    No preview · Article · Dec 2014 · Journal of applied biomechanics
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The patellofemoral pain syndrome (PFPS) is one of the most commonly encountered disorders involving the knee. The symptoms often lead to a reduction of physical activities resulting in sport- and job-related disabilities and the potential occurrence of severe disorders. Different theories for the development of the syndrome exist which result in different therapy modalities. A change in foot posture and its effect on lower limb kinematics seem to be one potential risk factor for the development of the syndrome. This leads to the assumption that foot orthoses might be a potential therapy device. Objectives: The aims of this study were to outline the state of evidence for the treatment of PFPS with foot orthoses and to identify the effect of foot orthoses on PFPS. Study Design: A systematic review of clinical (CT) and randomized controlled trials (RCT) was undertaken. Methods: A systematic search for studies (CT, RCT) was conducted using the databases of Medline (PubMed), Cochrane library, and PEDro. The relevance for further analysis of studies was reviewed on the basis of title and abstract. An additional search was undertaken using the reference lists of the included studies and additional literature as well as the PubMed function "related articles". Results: 11 studies were included in this analysis. The effect of different types of foot orthoses on pain, function and kinematics of the lower limb and muscle activation of selected lower limb muscles was analysed. Significant effects on pain and function were determined. A slight effect on kinematics of the lower limb and muscle activation of selected lower limb muscles was identified. Conclusion: Foot orthoses seem to be an effective treatment device in the therapy for PFPS. An immediate and long-term reduction in pain and an improvement of function occurred following the intervention. There was just a slight change in lower limb kinematics and muscle activation of selected lower limb muscles. The relationship between biomechanical effects of orthoses and pain still seems to be unclear. © Georg Thieme Verlag KG Stuttgart · New York.
    No preview · Article · Feb 2015 · Sportverletzung · Sportschaden
Show more

We use cookies to give you the best possible experience on ResearchGate. Read our cookies policy to learn more.