Variations in Foot Posture and Mobility Between Individuals with Patellofemoral Pain and Those in a Control Group (original) (raw)
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Study Design: Cross-sectional study of adults with PFP. Background: Aetiology of PFP is multifactorial, with intrinsic factors ranging from proximal and distal deficiencies relative to the knee. In healthy populations, relationships between foot and ankle mobility, and FPPA have been established, however, no studies have explored this relationship in PFP subjects. Objectives: Evaluate relationship between foot and ankle mobility, frontal plane projection angle (FPPA) and hip adduction angle (HADD) in adults with patellofemoral pain (PFP). Methods: 69 adults with PFP (subjects: 46 females and 23 males; mean age: 35.4(6.5) years) were assessed for foot and ankle mobility (weight bearing ankle dorsiflexion, midfoot arch height mobility and midfoot width mobility). Subjects were videoed performing 5 single leg squats (SLSq) bilaterally. FPPA and HADD of the SLSq were analysed using a 2-D video analysis system (Neorehab). Multiple linear regression models were used to examine the relationship between foot mobility and frontal plane angles. Results: Less ankle dorsiflexion range of motion (ROM) was a significant predictor of increased peak FPPA (β-1.189, 95% CI [-1.685 to -0.694], p<0.001) and increased peak HADD (β 0.851, 95% CI [.512 to 1.191], p<0.001). Arch height and midfoot width mobility were not associated with frontal plane angle measures (all p>0.05). Conclusion: Less ankle mobility is associated with greater FPPA and HADD, Improving ankle dorsiflexion ROM could reduce dynamic knee valgus, improving functional biomechanics for PFP individuals. Key Words: ankle dorsiflexion, fppa, hadd, ankle dorsiflexion, physical therapy
Journal of Foot and Ankle Research, 2011
Background: Foot posture assessment is commonly undertaken in clinical practice for the evaluation of individuals with patellofemoral pain syndrome (PFPS), particularly when considering prescription of foot orthoses. However, the validity of static assessment to provide insight into dynamic function in individuals with PFPS is unclear. This study was designed to evaluate the extent to which a static foot posture measurement tool (the Foot Posture Index -FPI) can provide insight into kinematic variables associated with foot pronation during level walking in individuals with PFPS and asymptomatic controls. Methods: Twenty-six individuals (5 males, 21 females) with PFPS aged 25.1 ± 4.6 years and 20 control participants (4 males, 16 females) aged 23.4 ± 2.3 years were recruited into the study. Each participant underwent clinical evaluation of the FPI and kinematic analysis of the rearfoot and forefoot during walking using a three-dimensional motion analysis system. The association of the FPI score with rearfoot eversion, forefoot dorsiflexion, and forefoot abduction kinematic variables (magnitude, timing of peak and range of motion) were evaluated using partial correlation coefficient statistics with gait velocity entered as a covariate. Results: A more pronated foot type as measured by the FPI was associated with greater peak forefoot abduction (r = 0.502, p = 0.013) and earlier peak rearfoot eversion relative to the laboratory (r = -0.440, p = 0.031) in the PFPS group, and greater rearfoot eversion range of motion relative to the laboratory (r = 0.614, p = 0.009) in the control group. Conclusion: In both individuals with and without PFPS, there was fair to moderate association between the FPI and some parameters of dynamic foot function. Inconsistent findings between the PFPS and control groups indicate that pathology may play a role in the relationship between static foot posture and dynamic function. The fair association between pronated foot posture as indicated by the FPI and earlier peak rearfoot eversion relative to the laboratory observed exclusively in those with PFPS is consistent with the biomechanical model of PFPS development. However, prospective studies are required to determine whether this relationship is causal.
Gait study of patients with patellofemoral pain syndrome
Gait & Posture, 1997
Patellofemoral pain syndrome is a frequent knee impairment in young adults. This study investigated the kinematic and kinetic gait patterns of individuals suffering from patellofemoral pain syndrome (PFPS). It was hypothesized that PFPS subjects modify their gait pattern in order to reduce loading on the painful patellofemoral joint. To verify this, the gait pattern of five subjects with right chronic PFPS was compared with that of five healthy subjects. Spatiotemporal, kinematic and kinetic data were collected from five gait cycles. The joint moments at the hip, knee and ankle joints were calculated using an inverse dynamic approach and the values were normalized to body weight (N-m/kg). Individual joint moments were expressed as a percentage of the support moment in order to quantify possible compensatory strategies. The kinematic analysis revealed a significant reduction of the knee flexion angle (ANOVAs, P < 0.01) occurring at lO%, 20% and 70% of the gait cycle. There were no significant differences between the two groups of subjects (ANOVAs, P > 0.05) as far as the individual joint moments and their contribution to the support moment were concerned. However, modifications were observed in the knee and hip moments between loo/o and 20% of the gait cycle. These modifications may suggest that PFPS subjects alter their gait pattern in order to reduce loading of the patellofemoral joint to avoid pain.
Kinematic gait characteristics associated with patellofemoral pain syndrome: A systematic review
Gait & Posture, 2009
Development of patellofemoral pain syndrome (PFPS) is considered to be multifactorial. The aims of this systematic review were to (i) summarise and critique the body of literature addressing kinematic gait characteristics associated with PFPS; and (ii) provide recommendations for future research addressing kinematic gait characteristics associated with PFPS. A comprehensive search of MEDLINE, EMBASE, CINAHL, and Current Contents revealed 561 citations for review. Each citation was assessed for inclusion and quality using a modified version of the 'Quality Index' and a novel inclusion/exclusion criteria checklist by two independent reviewers. A total of 24 studies were identified. No prospective studies with adequate data to complete effect size calculations were found. Quality of included case-control studies varied, with a number of methodological issues identified. Heterogeneity between studies made meta-analysis inappropriate. Reductions in gait velocity were indicated during walking, ramp negotiation, and stair negotiation in individuals with PFPS. Findings indicated delayed timing of peak rearfoot eversion and increased rearfoot eversion at heel strike transient during walking; and delayed timing of peak rearfoot eversion, increased rearfoot eversion at heel strike, reduced rearfoot eversion range, greater knee external rotation at peak knee extension moment, and greater hip adduction during running in individuals with PFPS. There is a clear need for prospective evaluation of kinematic gait characteristics in a PFPS population to distinguish between cause and effect. Where possible, future PFPS case-control studies should consider evaluating kinematics of the knee, hip and foot/ankle simultaneously with larger participant numbers. Completing between sex comparisons when practical and considering spatiotemporal gait characteristics during methodological design and data analysis is also recommended. ß
Influence of exercises on patellar height in women with patellofemoral pain syndrome
Acta Ortopédica Brasileira, 2014
Objective: To evaluate the patellar height of volunteers with and without patellofemoral pain syndrome (PPS) during maximal voluntary isometric contraction (MVIC) in open kinetic chain (OKC) and closed kinetic chain (CKC) exercises. Methods: Twenty healthy women, and nineteen women with patellofemoral pain syndrome were evaluated and subjected to nuclear magnetic resonance imaging during rest and MVIC in OKC and CKC at 15°, 30°, and 45° knee flexion. The patellar height was assessed by the K-Pacs program,using the Insall-Salvati index. For each exercise and knee position, patellar height was measured three times and the procedure was repeated after seven days. Results: These data did not confirm our hypothesis that OKC exercises promote increased patellar height. Conclusion: Patellar height is not associated with PPS and suggests that CKC exercises lead an increased patellar height during knee position at 15º and 45º flexion for the PPS group. Level of Evidence II, Comparative Prospective.
Comparison of isometric ankle strength between females with and without patellofemoral pain syndrome
International journal of sports physical therapy, 2014
Proximal and distal influences on the knee may be related as etiological factors of patellofemoral pain syndrome (PFPS). The distal factors include subtalar excessive pronation as well as medial tibia rotation, but no study has investigated whether ankle weakness could lead to alterations that influence the patellofemoral joint. Thus, the purpose of this study was to compare the ankle dorsiflexor and invertor muscles strength, as well as rearfoot eversion and the Navicular Drop Test (NDT) in females with PFPS to a control group of females of similar demographics without PFPS. Forty females, between 20 and 40 years of age (control group: n=20; PFPS group: n=20) participated. Rearfoot eversion range of motion and the NDT were assessed for both groups. The Numeric Pain Rating Scale and the Anterior Knee Pain Scale were used to evaluate the level of pain and the functional capacity of the knee during activities, respectively. Isometric ankle dorsiflexor and invertor strength was measure...
PLOS ONE, 2020
Patellofemoral pain (PFP) is commonly caused by abnormal pressure on the knee due to excessive load while standing, squatting, or going up or down stairs. To better understand the pathophysiology of PFP, we conducted a noninvasive patellar tracking study using a Carm computed tomography (CT) scanner to assess the non-weight-bearing condition at 0k nee flexion (NWB0˚) in supine, weight-bearing at 0˚(WB0˚) when upright, and at 30(WB30˚) in a squat. Three-dimensional (3D) CT images were obtained from patients with PFP (12 women, 6 men; mean age, 31 ± 9 years; mean weight, 68 ± 9 kg) and control subjects (8 women, 10 men; mean age, 39 ± 15 years; mean weight, 71 ± 13 kg). Six 3D-landmarks on the patella and femur were used to establish a joint coordinate system (JCS) and kinematic degrees of freedom (DoF) values on the JCS were obtained: patellar tilt (PT,˚), patellar flexion (PF,˚), patellar rotation (PR,˚), patellar lateral-medial shift (PT x , mm), patellar proximal-distal shift (PT y , mm), and patellar anterior-posterior shift (PT z , mm). Tests for statistical significance (p < 0.05) showed that the PF during WB30˚, the PT y during NWB0˚, and the PT z during NWB0˚, WB0˚, and WB30˚showed clear differences between the patients with PFP and healthy controls. In particular, the PF during WB30˚(17.62˚, extension) and the PT z during WB0˚(72.50 mm, posterior) had the largest rotational and translational differences (JCS Δ = patients with PFP-controls), respectively. The JCS coordinates with statistically significant difference can serve as key biomarkers of patellar motion when evaluating a patient suspected of having PFP. The proposed method could reveal diagnostic biomarkers for accurately identifying PFP patients and be an effective addition to clinical diagnosis before surgery and to help plan rehabilitation strategies.
Revista Brasileira de Ortopedia
Objective To compare the plantar pressure distribution and the kinematics of the rearfoot on the stance phase of subjects with or without patellofemoral pain syndrome (PFPS). Methods A total of 26 subjects with PFPS and 31 clinically healthy subjects, who were paired regarding age, height and mass, participated in the study. The plantar pressure distribution (peak pressure) was assessed in six plantar regions, as well as the kinematics of the rearfoot (maximum eversion angle, percentage of the stance phase when the maximum angle was reached, and percentage of the stance phase in which the rearfoot was in eversion). The data were analyzed by descriptive and inferential statistics, with a significance level of p ≤ 0.05. Results The pressure on the six plantar regions analyzed and the magnitude of the maximum eversion angle of the rearfoot when walking on flat surfaces did not present differences among the subjects with PFPS. However, the PFPS subjects showed, when walking, an earlier ...