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

Lieutenant Colonel TG Sutlive, PT, PhD, OCS, is Assistant Professor, US Army-Baylor University Graduate Program in Physical Therapy, Fort Sam Houston, Tex.
Lieutenant SD Mitchell, PT, MPT, is Staff Physical Therapist, Federal Medical Center Devens, Devens, Mass
Lieutenant SN Maxfield, PT, MPT, is Staff Physical Therapist, Federal Medical Center Carswell, Fort Worth, Tex
Captain CL McLean, PT, MPT, is Chief Physical Therapist, 67th Combat Support Hospital, Wuerzburg, Germany
Captain JC Neumann, PT, MPT, is Staff Physical Therapist, Ireland Army Community Hospital, Fort Knox, Ky
Captain CR Swiecki, PT, MPT, is Staff Physical Therapist, Walter Reed Army Medical Center, Washington, DC
Major RC Hall, PT, MS, ATC, SCS, is Chief, Physical Therapy Element, 86th MDOS, Ramstein Air Force Base, Germany
Captain AC Bare, PT, MPT, ATC, is Director of Sports Medicine, US Army World Class Athlete Program, Fort Carson, Colo
TW Flynn, PT, PhD, OCS, FAAOMPT, is Associate Professor, Department of Physical Therapy, Regis University, Denver, Colo

Address all correspondence to Dr Sutlive at Academy of Health Sciences (Attn: MCCS-HMT), Physical Therapy Branch, 3151 Scott Rd, Suite 1303, Fort Sam Houston, TX 78234-6138 (USA) (thomas.sutlive{at}cen.amedd.army.mil)

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.

Key Words: Knee pain • Orthotics • Patellofemoral • Physical examination • Rehabilitation

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