Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: Randomised clinical trial

Collins, Natalie, Crossley, Kay, Beller, Elaine, Darnell, Ross, McPoil, Thomas and Vicenzino, Bill (2009) Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: Randomised clinical trial. British Journal of Sports Medicine, 43 3: 169-176. doi:10.1136/bmj.a1735

Author Collins, Natalie
Crossley, Kay
Beller, Elaine
Darnell, Ross
McPoil, Thomas
Vicenzino, Bill
Title Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: Randomised clinical trial
Journal name British Journal of Sports Medicine   Check publisher's open access policy
ISSN 0306-3674
Publication date 2009-03-01
Year available 2008
Sub-type Article (original research)
DOI 10.1136/bmj.a1735
Open Access Status Not yet assessed
Volume 43
Issue 3
Start page 169
End page 176
Total pages 8
Place of publication London, England, U.K.
Publisher BMJ Group
Language eng
Subject C1
920201 Allied Health Therapies (excl. Mental Health Services)
110317 Physiotherapy
Formatted abstract
Objective To compare the clinical efficacy of foot orthoses
in the management of patellofemoral pain syndrome with
flat inserts or physiotherapy, and to investigate the
effectiveness of foot orthoses plus physiotherapy.
Design Prospective, single blind, randomised clinical trial.
Setting Single centre trial within a community setting in
Brisbane, Australia.
Participants 179 participants (100 women) aged 18 to
40 years, with a clinical diagnosis of patellofemoral pain
syndrome of greater than six weeks’ duration, who had no
previous treatment with foot orthoses or physiotherapy in
the preceding 12 months.
Interventions Six weeks of physiotherapist intervention
with off the shelf foot orthoses, flat inserts, multimodal
physiotherapy (patellofemoral joint mobilisation, patellar
taping, quadriceps muscle retraining, and education), or
foot orthoses plus physiotherapy.
Main outcome measures Global improvement, severity of
usual and worst pain over the preceding week, anterior
knee pain scale, and functional index questionnaire
measured at 6, 12, and 52 weeks.
Results Foot orthoses produced improvementbeyond that
of flat inserts in the short term, notably at six weeks
(relative risk reduction 0.66,99%confidence interval 0.05
to 1.17; NNT 4 (99% confidence interval 2 to 51). No
significant differences were found between foot orthoses
and physiotherapy, or between physiotherapy and
physiotherapy plus orthoses. All groups showed clinically
meaningful improvements in primary outcomes over
52 weeks.
Conclusion While foot orthoses are superior to flat inserts
according to participants’ overall perception, they are
similar to physiotherapy and do not improve outcomes
when added to physiotherapy in the short term
management of patellofemoral pain. Given the long term
improvement observed in all treatment groups, general
practitioners may seek to hasten recovery by prescribing
prefabricated orthoses.
Keyword Anterior knee pain
Lower-limb kinematics
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes This article was original published ONLINE FIRST 24 October 2008; BMJ, Volume 337, Issue 7677

Document type: Journal Article
Sub-type: Article (original research)
Collections: ERA 2012 Admin Only
School of Public Health Publications
School of Health and Rehabilitation Sciences Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 84 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 61 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Wed, 03 Mar 2010, 00:09:52 EST by Meredith Downes on behalf of School of Health & Rehabilitation Sciences