Skip to main content
SpringerLink
Log in

The Efficacy of Foot Orthoses in the Treatment of Individuals with Patellofemoral Pain Syndrome

A Systematic Review

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Patellofemoral pain syndrome (PFPS) is a highly prevalent condition, often reducing functional performance and being linked to osteoarthritis development later in life. Prescribing foot orthoses is often advocated, although the link between foot mechanics and PFPS development remains unclear. This systematic review was conducted to summarize and critique the existing evidence for the efficacy of foot orthoses in individuals with PFPS and to provide guidance for future research evaluating foot orthoses in individuals with PFPS. A comprehensive search of MEDLINE, EMBASE, CINAHL® and Current Contents revealed 138 citations for review. Two of the authors independently reviewed and assessed each citation for inclusion and quality using a modified version of the quality assessment scale for randomized controlled trials in PFPS designed by Bizzini and colleagues. A total of seven studies were included in the final review. The review found limited evidence that prefabricated foot orthoses may reduce the range of transverse plane knee rotation and provide greater short-term improvements in individuals with PFPS compared with flat inserts. Findings also indicated that combining physiotherapy with prefabricated foot orthoses may be superior to prefabricated foot orthoses alone. Further research is now needed to establish the mechanisms behind the efficacy of foot orthoses and to identify individuals with PFPS who are most likely to benefit from prescription of foot orthoses. A comparison of the efficacy between prefabricated and customized foot orthoses is also needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Fig. 1
Table IV
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Ireland ML, Willson JD, Ballantyne BT, et al. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 2003 Nov; 33 (11): 671–6

    PubMed  Google Scholar 

  2. Feller JA, Amis AA, Andrish JT, et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy 2007 May; (5): 542–53

    Google Scholar 

  3. Baquie P, Brukner P. Injuries presenting to an Australian Sports Medicine Centre: a 12-month study. Clin J Sport Med 1997; 7: 28–31

    Article  PubMed  CAS  Google Scholar 

  4. Taunton J, Ryan M, Clement D, et al. A retrospective casecontrol analysis of 2002 running injuries. Br J Sports Med 2002; 36: 95–101

    Article  PubMed  CAS  Google Scholar 

  5. Clement D, Taunton J, Smart G, et al. A survey of overuse running injuries. Phys Sportsmed 1981; 95 (5): 47–58

    Google Scholar 

  6. D’Hondt N, Struijs P, Kerkhoffs G, et al. Orthotic devices for treating patellofemoral pain syndrome. Cochrane Database Syst Rev 2002; (2): CD002267

  7. Gross MT, Foxworth JL. The role of foot orthoses as an intervention for patellofemoral pain. J Orthop Sports Phys Ther 2003 Nov; 33 (11): 661–70

    PubMed  Google Scholar 

  8. Brukner P, Kahn K, Crossley K, et al. Anterior knee pain. In: Brukner P, Kahn K, editors. Clinical sports medicine. 3rd ed. Sydney: McGraw-Hill, 2007: 506–37

    Google Scholar 

  9. McConnell J. The management of chondromalacia patellae: a long term solution. Aust J Physiother 1986; 32 (4): 215–23

    Google Scholar 

  10. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoreticalperspective. J Orthop Sports Phys Ther 2003 Nov; 33 (11): 639–46

    PubMed  Google Scholar 

  11. Outerbridge AR, Micheli LJ. Overuse injuries in the young athlete. Clin Sports Med 1995; 14 (3): 503–16

    PubMed  CAS  Google Scholar 

  12. Devereaux M, Lachman S. Patellofemoral arthralgia in athletes attending a sports injury clinic. Br J Sports Med 1984; 18: 18–21

    Article  PubMed  CAS  Google Scholar 

  13. Sandow M, Goodfellow J. The natural history of anterior knee pain in adolescents. J Bone Joint Surg 1985; 67B: 36–8

    Google Scholar 

  14. Nimon G, Murray D, Sandow M, et al. Natural history of anterior knee pain. J Pediatr Orthop 1985; 18: 118–22

    Google Scholar 

  15. Thorstensson CA, Andersson ML, Jonsson H, et al. The natural course of knee osteoarthritis in middle-agedindividuals with knee pain: a 12 year follow-up usingclinical and radiographic criteria. Ann Rheum Dis Epub 2008 Dec

    Google Scholar 

  16. Thorstensson CA, Petersson IF, Jacobsson LT, et al. Reduced functional performance in the lower extremity predictedradiographic knee osteoarthritis five years later. Ann Rheum Dis 2004 Apr; 63 (4): 402–7

    Article  PubMed  CAS  Google Scholar 

  17. Tiberio D. The effect of excessive subtalar joint pronation on patellofemoral mechanics: a theoretical model. J Orthop Sports Phys Ther 1987; 9: 160–5

    PubMed  CAS  Google Scholar 

  18. McPoil T, Vicenzino B, Cornwall M, et al. Variations in foot posture and mobility between individuals with anteriorknee pain and controls. J Orthop Sports Phys Ther 2007; 37 (1): A15

    Google Scholar 

  19. Levinger P, Gilleard W. An evaluation of the rearfoot posture in individuals with patellofemoral pain syndrome. J Sports Sci Med 2004; 3 (YISI1): 8–14

    Google Scholar 

  20. Duffey MJ, Martin DF, Cannon DW, et al. Etiologic factors associated with anterior knee pain in distance runners. Med Sci Sports Exerc 2000 Nov; 32 (11): 1825–32

    Article  PubMed  CAS  Google Scholar 

  21. Earl JE, Hertel J, Denegar CR. Patterns of dynamic malalignment, muscle activation, joint motion, and patellofemoralpain syndrome. J Sport Rehabil 2005 Aug; 14 (3): 215–33

    Google Scholar 

  22. Dierks TA, Manal KT, Hamill J, et al. Proximal and distal influences on hip and knee kinematics in runners withpatellofemoral pain during a prolonged run. J Orthop Sports Phys Ther 2008 Aug; 38 (8): 448–56

    PubMed  Google Scholar 

  23. Callaghan MJ, Baltzopoulos V. Gait analysis in patients with anterior knee pain. Clin Biomech 1994 Mar; 9 (2): 79–84

    Article  Google Scholar 

  24. Levinger P, Gilleard W. The heel strike transient during walking in subjects with patellofemoral pain syndrome. Phys Ther Sport 2005; 6 (2): 83–8

    Article  Google Scholar 

  25. Levinger P, Gilleard W. Tibia and rearfoot motion and ground reaction forces in subjects with patellofemoral painsyndrome during walking. Gait Posture 2007 Jan; 25 (1) 2–8

    Article  PubMed  Google Scholar 

  26. Dierks T, Davis I, Hamill J. Lower extremity joint timing during prolonged treadmill running in runners withpatellofemoral joint pain: American College of SportsMedicine annual conference [abstract]. Med Sci Sports Exerc 2006 s121

    Google Scholar 

  27. Hetsroni I, Finestone A, Milgrom C, et al. A prospective biomechanical study of the association between foot pronation and the incidence of anterior knee pain amongmilitary recruits. J Bone Joint Surg 2006; 88-B (7): 905–8

    Article  Google Scholar 

  28. Witvrouw E, Lysens R, Bellemans J, et al. Intrinsic risk factors for the development of anterior knee pain in anathletic population: a two-year prospective study. Am JSports Med 2000; 28 (4): 480–9

    CAS  Google Scholar 

  29. McConnell J. The physical therapists approach to patellofemoral disorders. Clin Sports Med 2002 Jul; 21 (3): 363–87

    Article  PubMed  Google Scholar 

  30. Zammit GV, Payne CB. Relationship between positive clinical outcomes of foot orthotic treatment and changesin rearfoot kinematics. J Am Podiatr Med Assoc 2007 May-Jun; 97 (3): 207–12

    PubMed  Google Scholar 

  31. Payne CB. The past, present, and future of podiatric biomechanics. J Am Podiatr Med Assoc 1998 Feb; 88 (2): 53–63

    PubMed  CAS  Google Scholar 

  32. Hertel J, Sloss BR, Earl JE. Effect of foot orthotics on quadriceps and gluteus medius electromyographic activityduring selected exercises. Arch Phys Med Rehabil 2005 Jan; 86 (1): 26–30

    Article  PubMed  Google Scholar 

  33. Nigg BM, Nurse MA, Stefanyshyn DJ. Shoe inserts and orthotics for sport and physical activities. Med Sci Sports Exerc 1999 Jul; 31 (7 Suppl.): S421–8

    Google Scholar 

  34. Barton CJ, Webster KE, Menz HB. Evaluation of the scope and quality of systematic reviews on nonpharmacologicalconservative treatment for patellofemoral pain syndrome. J Orthop Sports Phys Ther 2008 Sep; 38 (9): 529–41

    PubMed  Google Scholar 

  35. Heintjes E, Berger M, Bierma-Zeinstra S, et al. Exercise therapy for patellofemoral pain syndrome. CochraneDatabase Syst Rev 2003; (4): CD003472

  36. Bizzini M, Childs JD, Piva SR, et al. Systematic review of the quality of randomized controlled trials for patellofemoralpain syndrome. J Orthop Sports Phys Ther 2003; 33 (1) 4–20

    PubMed  Google Scholar 

  37. Portney L, Watkins C. Foundations of clinical research: applications to practice. 2nd ed. Upper Saddle River (NJ): Prentice-Hall, 2000

    Google Scholar 

  38. Collins N, Crossley K, Beller E, et al. Foot orthoses and physiotherapy in the treatment of patellofemoral painsyndrome: randomised clinical trial. Br Med J 2008; 337: a1735

    Article  Google Scholar 

  39. Eng JJ, Pierrynowski MR. The effect of soft foot orthotics on three-dimensional lower-limb kinematics during walkingand running. Phys Ther 1994 Sep; 74 (9): 836–44

    PubMed  CAS  Google Scholar 

  40. Johnston LB, Gross MT. Effects of foot orthoses on quality of life for individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther 2004 Aug; 34 (8): 440–8

    PubMed  Google Scholar 

  41. Pitman D, Jack D. A clinical investigation to determine the effectiveness of biomechanical foot orthoses as initialtreatment for patellofemoral pain syndrome. J Prosthet Orthot 2000; 12 (4): 110–6

    Google Scholar 

  42. Amell TK, Stothart JP, Kumar S. The effectiveness of functional foot orthoses as a treatment for patellofemoralstress syndrome: the clients perspective. Physiother Can 2000; 52 (2): 153–7

    Google Scholar 

  43. Sutlive TG, Mitchell SD, Maxfield SN, et al. Identification of individuals with patellofemoral pain whose symptomsimproved after a combined program of foot orthosis useand modified activity: a preliminary investigation. Phys Ther 2004 Jan; 84 (1): 49–61

    PubMed  Google Scholar 

  44. Eng JJ, Pierrynowski MR. Evaluation of soft foot orthotics in the treatment of patellofemoral pain syndrome, including commentary by Maffulli N with author response. Phys Ther 1993; 73 (2): 62–70

    PubMed  CAS  Google Scholar 

  45. Saxena A, Haddad J. The effect of foot orthoses on patellofemoral pain syndrome. Lower Extremity 1998; 5 (2): 95–102

    Google Scholar 

  46. Saxena A, Haddad J.The effect of foot orthoseson patellofemoral pain syndrome. J Am Podiatr Med Assoc 2003 Jul-Aug; 934264–71

    PubMed  Google Scholar 

  47. Neptune RR, Wright IC, van den Bogert PT. The influence of orthotic devices and vastus medialis strength and timingon patellofemoral loads during running. Clin Biomech 2000 Oct; 15 (8): 611–8

    Article  CAS  Google Scholar 

  48. MacLean CL, Davis IS, Hamill J. Short- and long-term influences of a custom foot orthotic intervention on lowerextremity dynamics. Clin J Sport Med 2008 Jul; 18 (4): 338–43

    PubMed  Google Scholar 

  49. Razeghi M, Batt ME. Foot type classification: a critical review of current methods. Gait Posture 2002 Jun; 15 (3): 282–91

    Article  PubMed  Google Scholar 

  50. Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoralpain syndrome. J Orthop Sports Phys Ther 2007; 37 (5): 232–8

    PubMed  Google Scholar 

  51. Bolgla LA, Malone TR, Umberger BR, et al. Hip strength and hip and knee kinematics during stair descent in femaleswith and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 2008 Jan; 38 (1): 12–8

    PubMed  Google Scholar 

  52. Cowan SM, Crossley KM, Bennell KL. Altered hip and trunk muscle function in individuals with patellofemoralpain. Br J Sports Med 2008 Oct 9; 43 (8): 584–8

    Article  PubMed  Google Scholar 

  53. Brindle TJ, Mattacola C, McCrory J. Electromyographic changes in the gluteus medius during stair ascent anddescent in subjects with anterior knee pain. Knee Surg Sports Traumatol Arthrosc 2003 Jul; 11 (4): 244–51

    Article  PubMed  Google Scholar 

  54. Cowan SM, Bennell KL, Hodges PW, et al. Delayed onset of electromyographic activity of vastus medialis obliquusrelative to vastus lateralis in subjects with patellofemoralpain syndrome. Arch Phys Med Rehabil 2001 Feb; 82 (2): 183–9

    Article  PubMed  CAS  Google Scholar 

  55. Cowan SM, Hodges PW, Bennell KL, et al. Altered vastii recruitment when people with patellofemoral pain syndromecomplete a postural task. Arch Phys Med Rehabil 2002 Jul; 83 (7): 989–95

    Article  PubMed  Google Scholar 

  56. Cowan SM, Bennell KL, Crossley KM, et al. Physical therapy alters recruitment of the vasti in patellofemoral painsyndrome. Med Sci Sports Exerc 2002 Dec; 34 (12): 1879–85

    Article  PubMed  Google Scholar 

  57. Nakagawa TH, Muniz TB, Baldon M, et al. The effect of additional strengthening of hip abductor and lateral rotatormuscles in patellofemoral pain syndrome: a randomizedcontrolled pilot study. Clin Rehabil 2008 Dec; 22 (12): 1051–60

    Article  PubMed  Google Scholar 

  58. Mascal CL, Landel R, Powers C. Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function:2 case reports. J Orthop Sports Phys Ther 2003 Nov; (11): 647–60

    Google Scholar 

  59. Stefanyshyn DJ, Hettinga BA. Running injuries and orthotics. Int Sport Med J 2006; 7 (2): 109–19

    Google Scholar 

  60. Stefanyshyn DJ, Stergiou P, Lun VMY, et al. Knee angular impulse as a predictor of patellofemoral pain in runners. Am J Sports Med 2006 Nov; 34 (11): 1844–51

    Article  PubMed  Google Scholar 

  61. Hinman RS, Payne C, Metcalf BR, et al. Lateral wedges in knee osteoarthritis: what are their immediate clinical andbiomechanical effects and can these predict a three-monthclinical outcome? Arthritis Rheum 2008 Mar 15; 59 (3): 408–15

    Article  PubMed  Google Scholar 

  62. Verhagen AP, de Vet HC, de Bie RA, et al. The Delphi list: a criteria list for quality assessment of randomized clinicaltrials for conducting systematic reviews developed byDelphi consensus. J Clin Epidemiol 1998 Dec; 51 (12): 1235–41

    Article  PubMed  CAS  Google Scholar 

  63. Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials:explanation and elaboration. Ann Intern Med 2001 Apr 17; 134 (8): 663–94

    PubMed  CAS  Google Scholar 

  64. Crossley K, Bennell K, Green S, et al. Physical therapy for patellofemoral pain: a randomized, double-blinded,placebo-controlled trial. Am J Sports Med 2002 Nov-Dec; (6): 857–65

    Google Scholar 

Download references

Acknowledgements

H.B. Menz is currently a National Health and Medical Research Council of Australia fellow (Clinical Career Development Award, ID: 433049).

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, Australia

    Christian J. Barton

  2. Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, 3086, Australia

    Christian J. Barton, Shannon E. Munteanu & Hylton B. Menz

  3. Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, Australia

    Shannon E. Munteanu

  4. Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia

    Kay M. Crossley

  5. School of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia

    Kay M. Crossley

Authors
  1. Christian J. Barton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shannon E. Munteanu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hylton B. Menz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kay M. Crossley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian J. Barton.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barton, C.J., Munteanu, S.E., Menz, H.B. et al. The Efficacy of Foot Orthoses in the Treatment of Individuals with Patellofemoral Pain Syndrome. Sports Med 40, 377–395 (2010). https://doi.org/10.2165/11530780-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11530780-000000000-00000

Keywords

Search

Navigation