ARE YOU USING ORTHOTICS FOR KNEE PAIN?

    Knee pain, particularly patellofemoral pain is a common complaint seen in family medicine, orthopedic and sports clinics, running and sports shops. Although the use of foot orthotics has been widely used by health professionals many over-the-counter versions exist and are purchased regularly (can you say Dr. Scholls?). Foot orthoses have been used for a variety of painful conditions including foot/ankle pain, back pain, diabetes, and hip pain.
Determining which individuals may actually benefit from the use of the orthotics for complaints of knee pain have yet to be identified. There have been several studies evaluating the use of orthotics in individuals with patellofemoral pain syndrome with the intention to develop clinical prediction rules. Vincenzo et al identified that those most likely receiving benefit were those who were older individuals, shorter individuals, individuals with lower baseline pain, and those with greater foot mobility. Another study by Sutlive et al identified three different predictors: greater forefoot valgum, reduced first metatarsophalangeal joint dorsiflexion, and reduced navicular drop. Restricted ankle dorsiflexion range has also been reported to be a potential indicator for the use of foot orthotics.This recent study by Barton et al, in Medicine & Science in Sports & Exercise was aimed at developing a preliminary clinical prediction rule to help identify individuals with patellofemoral pain syndrome who might most likely benefit from foot orthotics. The results of the study showed that 25% of the participants demonstrated marked improvement in a 12 week program of non-custom orthotics wear.
The number of participants with marked improvement increased to 78%. When three of the four criteria were met:

•   Foot wear motion control properties score of less than 5.0, which indicated less supportive footwear properties
•   Reports of less than 22 mm on a visual analogue scale (lower levels of pain)
•   Ankle dorsiflexion range motion with the knee flexed less than 41°
•   Reduced pain with a single leg squat while wearing the orthoses.

There were several takeaways for me in this article. First, the article mentions several outcome measures that I was not familiar with – the links are attached below. Some of these outcome tools might be of benefit to some clinicians and researchers.

Secondly, I think that the easiest measures that can be performed quickly in the clinic would be that of assessing ankle dorsiflexion range motion and determining immediate reduction of pain with a single leg squat while wearing the orthoses.

      And finally there is mention in the article that patients often do not respond to just one single intervention tool. Therefore, continuing to perform a comprehensive examination including hip/core strength and joint mobility would certainly seem to more than likely help in reducing knee pain in conjunction with the use of orthotics.  Let’s not forget about addressing other health issues such as weight and general physical inactivity.

Comments? Questions?

OUTCOME TOOLS to check out:
International Physical Activity Questionnaire
Footwear Assessment Tool
Foot Posture Index

Ref: Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain BARTON, CHRISTIAN J.; MENZ, HYLTON B.; CROSSLEY, KAY M. Medicine & Science in Sports & Exercise. 43(9):1603-1610, September 2011.

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