Grand Valley State University ScholarWorks@GVSU Masters Theses Graduate Research and Creative Practice 2000 The ffecE tiveness of Using Foot Orthotics as the Sole Intervention for the Treatment of Patellofemoral Pain Syndrome Byron Horner Grand Valley State University Follow this and additional works at: http://scholarworks.gvsu.edu/theses Part of the Physical Therapy Commons Recommended Citation Horner, Byron, "The Effectiveness of Using Foot Orthotics as the Sole Intervention for the Treatment of Patellofemoral Pain Syndrome" (2000). Masters Theses. 626. http://scholarworks.gvsu.edu/theses/626 This Thesis is brought to you for free and open access by the Graduate Research and Creative Practice at ScholarWorks@GVSU. It has been accepted for inclusion in Masters Theses by an authorized administrator of ScholarWorks@GVSU. For more information, please contact [email protected]. THE EFFECTIVENESS OF USING FOOT ORTHOTICS AS THE SOLE INTERVENTION FOR THE TREATMENT OF PATELLOFEMORAL PAIN SYNDROME By Byron Homer MASTERS' THESIS Submitted to the Department of Physical Therapy at Grand Valley State University Allendale, Michigan in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN PHYSICAL THERAPY 2000 THESIS COMMITTEE/RESEARCH ADVISOR A^ROVAL: /VicinberJk , Member Dele A L®co ^^^^ember Dale THE EFFECTIVENESS OF USING FOOT ORTHOTICS AS THE SOLE INTERVENTION FOR THE TREATMENT OF PATELLOFEMORAL PAIN SYNDROME ABSTRACT Patellofemoral pain syndrome (PFPS) is a common diagnosis treated by health care personnel. This study investigates the effectiveness of foot orthotics in the treatment of PFPS. Fourteen subjects experiencing PFPS participated. Each completed a Functional Pain Assessment (FPA) consisting of walking, stairs, biking, squatting and resting (sitting). Function was assessed using the Activities of Daily Living Scale (ADLS). After the initial FPA and ADLS. foot orthotics were placed in the shoes of participants and worn for the duration of the study. No other intervention was given. Follow-up testing was performed immediately after insertion of orthotics, after two weeks and again at four weeks in which subjects completed the FPA and ADLS. Results indicate that orthotics do not immediately decrease pain (p=.29). However, after two and four weeks, significant improvement was found (p=.004, p=.002) respectively. Functional improvements were found at both two and four weeks (p=.042. p=.014) respectively. This study does support the use of orthotics in the treatment of PFPS. ACKNOWLEDGEMENTS I wish to express appreciation to all members of my thesis committee for their time and effort in extending feedback and encouragement throughout the design, research and writing process. Thanks to Jolene Bennett for her willingness to be the chairperson of this committee and for her cooperation, advice and leadership. Barb Hoogenboom and Jim Scott provided critical reviews of the study design and valuable suggestions that strengthened the design of this study. Special thanks to Barb for her assistance with digital photography and to Jim for his supply and assistance with equipment used. 1 would like to thank John Gabrosek for his patience during many hours of data analysis and helping me accurately interpret the data. 1 owe a great deal of gratitude to Brent Hawkins for his etTorts in proofreading this document and giving valuable feedback which helped improve the cohesiveness of this thesis. Finally, thanks to all of the subjects who faithfully participated which made this study possible. DEFINITION OF TERMS Arthrokinematics: The movement of joint surfaces. Casting: A method of capturing the contours of the foot; typically done with the foot in subtalar neutral position. Closed chain: When the distal end of the chain is tlxed on the ground. Crepitus: Disruption of the normally smooth Joint surfaces. Is often associated with cartilage damage and Joint degeneration. Dorsiflexion: Movement around a horizontal axis between the talus and the medial and lateral malleolus resulting in a decrease in Joint angle. Eversion: An increase in the medial angulation of the calcaneus with the tibia. External tibial torsion: Lateral twisting within the shaft of the tibia. Femoral anteversion: Forward or anterior torsion of the femoral neck. Genu varum: The medial angle of the tibiofemoral Joint (knee) less than 180 degrees (bow legs). Genu valgum: The medial angle of the tibiofemoral Joint (knee) greater than 195 degrees (knock knees). Inversion: An increase in the lateral angulation of the calcaneus with the tibia. Kinematic chain: A series of Joints in which movement of one Joint produces movement in another. Kinematics: The study of movement. Open chain: When the distal end of the kinematics chain is tree to move in space. Orthotic: An orthopedic device used to support, align, or correct deformities to improve the function of movable segments of the foot. Plantarflexion: Movement around a horizontal axis between the talus and medial and lateral malleolus, resulting in an increased joint angle. Ill Post: The portion of an orthotic used to control abnormal movement. Pronation: Movement of the subtalar joint composed of abduction, eversion. and dorsiflexion of the calcaneus. Subtalar Neutral: The position of the subtalar Joint in which it is neither pronated or supinated, and the head of the talus can be palpated equally on the medial and lateral side. Supination: Movement of the subtalar Joint composed of adduction, inversion, and plantarflexion of the calcaneus. Tibial vara: Bowing of the tibia with a medial concavity. Valgus force: The force applied to the lateral surface of the Joint. Varus force: The force applied to the medial surface of the Joint. IV TABLE OF CONTENTS 1. ABSTRACT.......................................................................................................i 2. ACKNOWLEDGEMENTS.............................................................................ii 3. DEFINITION OF TERMS.............................................................................Hi 4. TABLE OF CONTENTS.................................................................................v 5. LIST OF TABLES........................................................................................... x 6. LIST OF FIGURES........................................................................................ xl 7. CHAPTER 1 ..................................................................................................... I Introduction ................................................................................................1 Background to Problem ......................................................................1 Problem Statement ............................................................................. 2 Purpose ................................................................................................ 2 Significance of the Problem ...............................................................2 Hypotheses..........................................................................................3 8. CHAPTER 2 .....................................................................................................4 review of the literature and conceptual framework ............................... 4 Anatomic and Biomechanical Considerations ...................................4 Subtalar Joint ...............................................................................................................4 Talocrural Joint (Ankle) .............................................................................................. 7 Tibiofemoral Joint (Knee) ...........................................................................................8 Patellofemoral Joint ...................................................................................................10 Classification of Disorders at the Patellofemoral Joint ................... 13 Excessive Lateral Pressure Syndrome ......................................................................13 Global Patellar Pressure Syndromes .........................................................................14 Patellar Instability......................................................................................................14 Lower Extremity Biomechanical Dysfunction ................................16 Malalignment of the Patella ......................................................................................17 Muscle Weakness .......................................................................................................18 Leg Length Discrepancy...........................................................................................20 Excessive Pronation .................................................................................................. 20 Direct Patellar Trauma ..............................................................................................21 V Soft Tissue Lesions and Abnormalities ................................................................... 22 Overuse Syndromes ................................................................................................... 23 Apophysitis.................................................................................................................25 Osteochondritis Dissecans o f the Patella ................................................................. 26 Common Treatment Strategies ........................................................27 Stretching....................................................................................................................27