Identification of Individuals With Patellofemoral Pain Whose Symptoms Improved After a Combined Program of Foot Orthosis Use and Modified Activity: A Preliminary Investigation

Abstract

Abstract Background and Purpose. In patients with patellofemoral pain syndrome (PFPS), the authors determined which aspects of the examination could be used to identify those patients most likely to respond to off-the-shelf foot orthoses and instruction in activity modification. Participants and Methods. Fifty participants were enrolled in the study, and data for 5 individuals were excluded from analysis. Thirty-four men and 11 women completed the study. Participants were given foot orthoses and instructed in activity modification for 3 weeks. A 50% reduction in pain was considered a success. Likelihood ratios (LRs) were computed to determine which examination findings were most predictive of success. Results. The best predictors of improvement were forefoot valgus alignment of ≥2 degrees (+LR=4.0, 95% confidence interval [CI]=0.7–21.9), great toe extension of ≤78 degrees (+LR=4.0, 95% CI=0.7–21.9), and navicular drop of ≤3 mm (+LR=2.4, 95% CI=1.3–4.3). Discussion and Conclusion. The results suggest that patients with PFPS who have forefoot valgus alignment of ≥2 degrees, passive great toe extension of ≤78 degrees, or navicular drop of ≤3 mm are most likely to respond favorably to initial intervention with an off-the-shelf foot orthosis and instruction in activity modification.