Immediate effects of foot orthoses on gait biomechanics in individuals with persistent patellofemoral pain

• Published in: Gait & posture 2020-03, Vol.77, p.20-28
• Main Authors: Hart, Harvi F., Crossley, Kay M., Bonacci, Jason, Ackland, David C., Pandy, Marcus G., Collins, Natalie J.
• Format: Article
• Language: English
• Subjects: Adult; Ankle; Ankle Joint - physiopathology; Biomechanical Phenomena - physiology; Evaluation Studies as Topic; Female; Foot Orthoses; Gait - physiology; Gait analyses; Gait Analysis; Hip; Hip Joint - physiopathology; Humans; Joint angles; Knee; Knee Joint - physiopathology; Male; Moments; Patellofemoral Pain Syndrome - physiopathology; Patellofemoral Pain Syndrome - therapy; Rotation; Running - physiology; Stair Climbing - physiology; Treatment Outcome; Walking
• ISSN: 0966-6362; 1879-2219
• DOI: 10.1016/j.gaitpost.2019.12.012

•Foot orthoses are associated with changes in gait biomechanics in people with PFP.•These changes occur during level walking, as well as stair ascent and descent.•Biomechanical changes with foot orthoses occur primarily at the ankle joint. The efficacy of foot orthoses in reducing patellofemoral pain (PFP) is well documented; however, the mechanisms by which foot orthoses modulate pain and function are poorly understood. This within-subject study investigated the immediate effects of foot orthoses on lower limb kinematics and angular impulses during level walking and stair ambulation in individuals with persistent PFP. Forty-two participants with persistent PFP (≥3 months duration) underwent quantitative gait analysis during level walking, stair ascent and stair descent while using: (i) standard running sandals (control); and (ii) standard running sandals fitted with prefabricated foot orthoses. Hip, knee, and ankle joint kinematics and angular impulses were calculated and statistically analyzed using paired t-tests (p < 0.05). Relative to the control condition, foot orthoses use was associated with small but significant decreases in maximum ankle inversion angles during walking (mean difference [95% confidence interval]: −1.00° [−1.48 to −0.53]), stair ascent (−1.06° [−1.66 to −0.45]) and stair decent (−0.94° [−1.40 to −0.49]). Foot orthoses were also associated with decreased ankle eversion impulse during walking (−9.8Nms/kg [−12.7 to −6.8]), and decreased ankle dorsiflexion and eversion impulse during stair ascent (−67.6Nms/kg [−100.7 to −34.6] and −17.5Nms/kg [−23.6 to −11.4], respectively) and descent (−50.4Nms/kg [−77.2 to −23.6] and −11.6Nms/kg [−15.6 to −7.5], respectively). Ankle internal rotation impulse decreased when participants ascended stairs with foot orthoses (−3.3Nms/kg [−5.4 to −1.3]). Limited changes were observed at the knee and hip. In individuals with persistent PFP, small immediate changes in kinematics and angular impulses – primarily at the ankle – were observed when foot orthoses were worn during walking or stair ambulation. The clinical implications of these small changes, as well as the longer-term effects of foot orthoses on lower limb biomechanics, are yet to be determined.