Identification of individuals with patellofemoral pain whose symptoms improved after a combined program of foot orthosis use and modified activity: a preliminary investigation.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
US Army-Baylor University Graduate Program in Physical Therapy, Fort Sam Houston, TX 78234-6138, USA. thomas.sutlive@cen.amedd.army.mil
Thomas G
TG
Sutlive
Scott D
SD
Mitchell
Stephanie N
SN
Maxfield
Cynthia L
CL
McLean
Jon C
JC
Neumann
Christine R
CR
Swiecki
Robert C
RC
Hall
Anthony C
AC
Bare
Timothy W
TW
Flynn
D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D018771:Arthralgia / Q000503:physiopathology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D005260:Female; D005269:Femur / Q000503:physiopathology*; D005528:Foot; D006801:Humans; D035002:Lower Extremity / Q000033:anatomy & histology; D008297:Male; D008889:Military Personnel; D009989:Orthotic Devices; D010043:Outcome and Process Assessment, Health Care; D010329:Patella / Q000503:physiopathology*; D010806:Physical Education and Training / Q000379:methods*; D011237:Predictive Value of Tests