Isaac Knott Student ID u3068884 FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Prevalence approximately 26 active population 1 Pain in retropatellar behind or ID: 934919
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FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Isaac Knott
Student
ID: u3068884
Slide2FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Prevalence = approximately 26% active population
[1].
Pain in retro-patellar (behind)
or
peri-patella (around)
[1].
Pain brought on through an increased
load through the patellofemoral joint [1-3].Prolonged walking, ascending/descending stairs, running, kneeling, squatting, prolonged sitting…
Image 1: Moveforwardpt.com. Patellofemoral Pain - MoveForwardPT.com [Internet]. 2014 [cited 14 September 2014]. Available from: http://www.moveforwardpt.com/symptomsconditionsdetail
Slide3FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Image 2: My Trainer Chris. Knee Strengthening for Females [Internet]. 2013 [cited 14 September 2014]. Available from: http://mytrainerchris.wordpress.com/2013/12/21/knee-strengthening-for-females/
Slide4FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
“Conservative
management is currently considered the principle treatment, with
foot orthoses
often prescribed in combination or as an alternative to other management strategies including taping, exercise prescription and
analgesics
(2)
”.
Slide5FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Foot orthoses are specially moulded devices designed to fit inside footwear
(1).
Many different variations and styles
Custom vs prefabricated
Hard, medium or soft
C
orrects
foot posture and
improves
lower limb
biomechanics thereby decreasing PFJ pain?
(1,3)
Image 3 & 4: Soleplatinum.blogspot.com.au. Sole Solutions: Custom Foot Orthotics Laboratory in Cayman! [Internet]. 2011 [cited 14 September 2014]. Available from: http://soleplatinum.blogspot.com.au/2011/06/custom-foot-orthotics-laboratory-in.html
Slide6FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Why is it important?
High prevalence
Decreases functional performance
Potential
to contribute to additional chronic
conditions
(
e.g osteoarthritis) Physiotherapists on the “frontline” in terms of treating such conditions Orthotics widely available
Slide7FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Slide8FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
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Slide10FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Evaluation
Strengths
Clearly
defined research
question.
E
xtensive
search for relevant papers using strict inclusion and exclusion criteria.Methods for each of the included trials were evaluated for bias.Results interpreted with appropriate applications for clinical practice.Protocols implemented to reduce the risk of bias through the selection and review process.Weaknesses
Only
two articles were
examined
P
revented
assessments of heterogeneity and
sensitivity
Neither
of the reviewed trials had a clearly defined control
group.
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Slide13FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Evaluation
Strengths
Systematic review – did include some RCT’s
Larger number of studies and participants
Weaknesses
Broad and multifaceted research question
Included case series and other lower quality study designs
Poor study design, poorly defined outcome measures and a lack of quantifiable data from the included studies.Little to no comparison between studies
High risk of bias in included studies
No clear conclusions drawn
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Evaluation
Strengths
Clearly
defined
control
Clear conclusion drawn
W
ell-designed methods that attempted to limit possible sources of bias (e.g. Blinding)WeaknessesLow participant
numbers
Shorter duration (6wks)
Orthoses supplied by prominent international manufacturer. Bias?
Slide17FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Summary
Evidence
around this topic seems to be
conflicting
Higher levels
of evidence
seem to
indicate that orthoses have little impact on PFJ pain over the long-term but there is a potentially a positive impact over the short term. Clear that there is a lack of high quality, well designed trials addressing this topic.
Slide18FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
What did I learn?
Patience.
How
to better recognise good quality
evidence.
A better ability to recognise
potential sources of
bias.The ability to recognise the clinical significance and potential impact of a good quality article.
Slide19FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN
Thank you!
Any Questions ?
Email: Zacknott@gmail.com
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References
1.Hossain
M, Alexander P, Burls A,
Jobanputra
P. Foot orthoses for patellofemoral pain in adults. Cochrane Database
Syst
Rev. 2011;1
.2.Barton MCJ, Munteanu SE, Menz HB, Crossley KM. The efficacy of foot orthoses in the treatment of individuals with patellofemoral pain syndrome. Sports Medicine. 2010;40(5):377-95.3.Mills K, Blanch P, Dev P, Martin M, Vicenzino B. A randomised control trial of short term efficacy of in-shoe foot orthoses compared with a wait and see policy for anterior knee pain and the role of foot mobility. British Journal of Sports Medicine. 2011:bjsports-2011-090204.4.Nhmrc.gov.au. Resources for guideline developers | National Health and Medical Research Council [Internet]. 2014 [cited 14 September 2014]. Available from: https://www.nhmrc.gov.au/guidelines/resources-guideline-developers