Foot orthoses for the treatment of patellofemoral pain
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Transcript of Foot orthoses for the treatment of patellofemoral pain
FOOT ORTHOSES FOR THE
TREATMENT OF PATELLOFEMORAL
JOINT PAIN
Isaac Knott
Student ID: u3068884
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Prevalence = approximately 26% active population [1].
Pain in retro-patellar (behind) or peri-patella (around) [1].
Pain brought on through an increased load through the patellofemoral joint [1-3].
Prolonged walking, ascending/descending stairs, running, kneeling, squatting, prolonged sitting…
Image 1: Moveforwardpt.com. Patellofemoral Pain - MoveForwardPT.com [Internet]. 2014 [cited 14 September 2014]. Available from: http://www.moveforwardpt.com/symptomsconditionsdetail
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Image 2: My Trainer Chris. Knee Strengthening for Females [Internet]. 2013 [cited 14 September 2014]. Available from: http://mytrainerchris.wordpress.com/2013/12/21/knee-strengthening-for-females/
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
“Conservative management is currently considered the principle
treatment, with foot orthoses often prescribed in combination or as an alternative to other management
strategies including taping, exercise prescription and analgesics(2)”.
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Foot orthoses are specially moulded devices designed to fit inside footwear (1).
Many different variations and styles
Custom vs prefabricated
Hard, medium or soft
Corrects foot posture and improves lower limb biomechanics thereby decreasing PFJ pain? (1,3)
Image 3 & 4: Soleplatinum.blogspot.com.au. Sole Solutions: Custom Foot Orthotics Laboratory in Cayman! [Internet]. 2011 [cited 14 September 2014]. Available from: http://soleplatinum.blogspot.com.au/2011/06/custom-foot-orthotics-laboratory-in.html
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Why is it important?
High prevalence Decreases functional performance Potential to contribute to additional chronic conditions (e.g
osteoarthritis) Physiotherapists on the “frontline” in terms of treating such
conditions Orthotics widely available
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
EvaluationStrengths
Clearly defined research question. Extensive search for relevant
papers using strict inclusion and exclusion criteria.
Methods for each of the included trials were evaluated for bias.
Results interpreted with appropriate applications for clinical practice.
Protocols implemented to reduce the risk of bias through the selection and review process.
Weaknesses
Only two articles were examined
Prevented assessments of heterogeneity and sensitivity
Neither of the reviewed trials had a clearly defined control group.
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
EvaluationStrengths
Systematic review – did include some RCT’s
Larger number of studies and participants
Weaknesses
Broad and multifaceted research question
Included case series and other lower quality study designs
Poor study design, poorly defined outcome measures and a lack of quantifiable data from the included studies.
Little to no comparison between studies
High risk of bias in included studies
No clear conclusions drawn
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
EvaluationStrengths
Clearly defined control
Clear conclusion drawn
Well-designed methods that attempted to limit possible sources of bias (e.g. Blinding)
Weaknesses
Low participant numbers
Shorter duration (6wks)
Orthoses supplied by prominent international manufacturer. Bias?
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Summary
Evidence around this topic seems to be conflicting
Higher levels of evidence seem to indicate that orthoses have little impact on PFJ pain over the long-term but there is a potentially a positive impact over the short term.
Clear that there is a lack of high quality, well designed trials addressing this topic.
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
What did I learn?
Patience. How to better recognise good quality evidence. A better ability to recognise potential sources of bias. The ability to recognise the clinical significance and
potential impact of a good quality article.
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
Thank you!
Any Questions ?
Email: [email protected]
FOOT ORTHOSES FOR THE TREATMENT OF
PATELLOFEMORAL JOINT PAIN
References
1.Hossain M, Alexander P, Burls A, Jobanputra P. Foot orthoses for patellofemoral pain in adults. Cochrane Database Syst Rev. 2011;1.
2.Barton MCJ, Munteanu SE, Menz HB, Crossley KM. The efficacy of foot orthoses in the treatment of individuals with patellofemoral pain syndrome. Sports Medicine. 2010;40(5):377-95.
3.Mills K, Blanch P, Dev P, Martin M, Vicenzino B. 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. British Journal of Sports Medicine. 2011:bjsports-2011-090204.
4.Nhmrc.gov.au. Resources for guideline developers | National Health and Medical Research Council [Internet]. 2014 [cited 14 September 2014]. Available from: https://www.nhmrc.gov.au/guidelines/resources-guideline-developers