Now 8 years ago, this paper from 2017 quietly validated the use of orthotic devices in patients with knee pain, particularly patellofemoral joint pain. The paper starts with the statistics that patellofemoral pain yearly occurs in about 25% of the general population, and even 36% of professional cyclists. The importance of good treatment is not only in preventing it in the first place, but it is based on the fact that 50% of these patients continue to have problems for up to 20 years. So, it is important to find out successful treatments. This paper was produced by an International Group of Scientists with minimal biases.
Recommendations from the expert panel on exercise therapy and physical interventions for patellofemoral pain are:
- Exercise therapy is recommended to reduce pain in the short, medium and long terms and improve function in the medium and long terms.
- Combining hip and knee exercises is recommended to reduce pain and improve function in the short, medium and long terms, and this combination should be used in preference to knee exercises alone.
- Combined interventions are recommended to reduce pain in adults with patellofemoral pain in the short and medium terms. Combined interventions as a management programme incorporates exercise therapy as well as one of the following: foot orthoses, patellar taping or manual therapy.
- Foot orthoses are recommended to reduce pain in the short term.
- Patellofemoral, knee and lumbar mobilisations are not recommended in isolation.
- Electrophysical agents are not recommended.
Therefore, the role of foot orthotic devices, which are always used as part of a comprehensive program should be used at the start of pain to get the knee more centered, typically controlling pronation, and coupled with external hip rotator strengthening and vastus medialis knee strengthening. The perfect triad. You can add generalized core strength and maintain fitness with non-painful cross training. I also love to add vastus lateralis stretching, and make sure the hamstrings have good strength and flexibility.
One final point, this paper only found enough research evidence in using prefabricated OTC foot inserts over custom made (like PowerStep™, PureStride™, Superfeet™ or Sole™). So many papers using many patients have to use the same shoe and same orthotic device essentially. By its nature, custom made orthotic devices that are individualized for a certain function to each foot, are a research nightmare. It puts too many variables into play that keep researchers up all night. So, I am okay to find that studies that only used OTC foot orthotic devices provide such good results for patients suffering from knee pain. I know that I can design a custom made functional foot orthotic device that will even do better.
