Moulded foot insoles for adults with pain around the knee cap

Pain around the knee cap is a common problem. The pain may be brought on or made worse by day to day or sporting/exercise activities. Pain around the knee cap can have many different causes, such as the way the knee cap glides over the bones or because of knee overuse. Several different treatment options are available. Foot orthoses are specially moulded devices fitted into footwear. They are believed to be helpful because they might help improve the alignment of the leg bones.

The aim of this review is to evaluate the effects of foot orthoses on knee pain and knee usage in adults with pain over the front of the knee. We aimed to compare foot orthoses against no treatment or flat insoles, or other treatments such as physiotherapy.

We included two studies with a total of 210 participants in this review. Both trials were at some risk of bias because not enough care had been taken to ensure that groups received the same treatment other than the interventions being tested. One trial found some benefits from using foot orthoses over simple insoles at six weeks but not at one year. Participants wearing orthoses were, however, more likely to report minor adverse effects (e.g. rubbing, blistering) and discomfort compared with those wearing insoles. There were no important differences in knee pain and function in people given foot orthoses as well as physiotherapy when compared with people given physiotherapy only. Results for knee pain and function did not show important differences between foot orthoses versus physiotherapy.

On the basis of the available evidence we do not recommend foot orthoses for adults with pain around the knee cap.

Authors' conclusions: 

While not robust, the available evidence does not reveal any clear advantage of foot orthoses over simple insoles or physiotherapy for patellofemoral pain. While foot orthoses may help relieve knee pain over the short term, the benefit may be marginal. Patients treated with orthoses are more likely to complain of mild adverse effects and discomfort.

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Background: 

Foot orthoses, which are specially moulded devices fitted into footwear, are one of the treatment options for patellofemoral or anterior knee pain.

Objectives: 

To assess the effects of foot orthoses for managing patellofemoral pain in adults.

Search strategy: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group’s Specialised Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to 2010 Week 11), CINAHL (1937 to March 2010), trial registers, reference lists and grey literature. No language restriction was applied.

Selection criteria: 

We included randomised or quasi-randomised clinical studies that compared foot orthoses with flat insoles or another physical therapy intervention. The primary outcomes were knee pain and knee function.

Data collection and analysis: 

Two authors independently selected eligible trials, assessed methodological quality and performed data extraction. We calculated risk ratios and 95% confidence intervals for dichotomous variables, and mean differences with 95% confidence intervals for continuous variables. We pooled data using the fixed-effect model.

Main results: 

Two trials with a total of 210 participants were included. Both trials were at some risk of performance bias. One trial had four intervention groups and the other had three. One trial found that foot orthoses when compared with flat insoles (control group) had better results at six weeks in knee pain (participants with global improvement: risk ratio 1.48, 95% confidence interval 1.11 to 1.99), but not at one year follow-up. Participants in the orthoses group reported significantly more minor adverse effects (e.g. rubbing, blistering) compared with the flat insole group (risk ratio 1.87, 95% confidence intervaI 1.21 to 2.91). Both trials in their comparisons of orthoses plus physiotherapy versus physiotherapy alone found no statistically significant differences between the two intervention groups in knee pain or function. Results for knee pain outcomes did not show significant differences between foot orthoses versus physiotherapy. Although participants in the physiotherapy group had consistently better results for the functional index questionnaire, the clinical relevance of these results is uncertain.

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