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 (2008) Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. British Medical Journal, 337 3: 169-U30. 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 Medical Journal
ISSN 0007-1447
Publication date 2008-01-01
Year available 2009
Sub-type Article (original research)
DOI 10.1136/bmj.a1735
Open Access Status Not Open Access
Volume 337
Issue 3
Start page 169
End page U30
Total pages 8
Place of publication London, United Kingdom
Publisher B M J Group
Language eng
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 improvement beyond 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 Sport Sciences
Sport Sciences
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Public Health Publications
School of Health and Rehabilitation Sciences Publications
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Citation counts: TR Web of Science Citation Count  Cited 134 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 04 Feb 2016, 02:41:42 EST by Dr Natalie Collins on behalf of School of Health & Rehabilitation Sciences