Do orthoses have a role in the treatment of Patellofemoral pain?

A concomitant explosion in overuse injuries in runners was linked to the running boom of the mid-1970’s. Foremost amongst these injuries was patellofemoral pain.

As a result of the increase in lower limb overuse injury, a great deal of attention was focussed on the biomechanics of the foot and lower leg.

Special interest was directed to the influence faulty foot biomechanics may have on anterior knee pain. Many researchers at this time felt that foot function was intimately linked to knee function and that patellofemoral pain was at least in part, caused by abnormal foot function. As a result of this viewpoint, there was widespread acceptance that the use of foot orthotic devices could positively influence the treatment of anterior knee pain generally, and patellofemoral pain specifically.

This trend continues today. However, despite compelling anecdotal evidence that orthoses may indeed be a useful treatment modality for patellofemoral pain, there has been little evidence to clarify the exact mechanism by which they may achieve a positive outcome. This paper reviews the current literature and proposes a new theory for the mechanism of foot orthotic action.

Anterior knee pain is one of the most common symptoms presenting in sports medicine practice and indeed in the non-athletic population.  Running especially is associated with high injury rates for both younger and older athletes 1.

Many different studies have cited specific injury rate, with van Mechalin 2 quoting an overall yearly incidence rate of 37% to 56% for running injury.  This same study found 42% of all running injuries related to the knee and 26% of knee injuries involved the patellofemoral joint. Patellofemoral pain refers to all disorders associated with discomfort on the anterior aspect of the knee joint and may include a diverse range of injury.

Simon Bartold
Director of Bartold Clinical

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