Immediate effects of foot orthoses on gait biomechanics in individuals with persistent patellofemoral pain

Background: The efficacy of foot orthoses in reducing patellofemoral pain (PFP) is well documented; however, the mechanisms by which foot orthoses modulate pain and function are poorly understood. Research question: This within-subject study investigated the immediate effects of foot orthoses on lower limb kinematics and angular impulses during level walking and stair ambulation in individuals with persistent PFP. Methods: Forty-two participants with persistent PFP (>= 3 months duration) underwent quantitative gait analysis during level walking, stair ascent and stair descent while using: (i) standard running sandals (control); and (ii) standard running sandals fitted with prefabricated foot orthoses. Hip, knee, and ankle joint kinematics and angular impulses were calculated and statistically analyzed using paired t-tests (p < 0.05). Results: Relative to the control condition, foot orthoses use was associated with small but significant decreases in maximum ankle inversion angles during walking (mean difference [95% confidence interval]: -1.00 degrees [-1.48 to -0.53]), stair ascent (-1.06 degrees [-1.66 to -0.45]) and stair decent (-0.94 degrees [-1.40 to -0.49]). Foot orthoses were also associated with decreased ankle eversion impulse during walking (-9.8Nms/kg [-12.7 to -6.8]), and decreased ankle dorsiflexion and eversion impulse during stair ascent (-67.6Nms/kg [-100.7 to -34.6] and -17.5Nms/kg [-23.6 to -11.4], respectively) and descent (-50.4Nms/kg [-77.2 to -23.6] and -11.6Nms/kg [-15.6 to -7.5], respectively). Ankle internal rotation impulse decreased when participants ascended stairs with foot orthoses (-3.3Nms/kg [-5.4 to -1.3]). Limited changes were observed at the knee and hip. Significance: In individuals with persistent PFP, small immediate changes in kinematics and angular impulses - primarily at the ankle - were observed when foot orthoses were worn during walking or stair ambulation. The clinical implications of these small changes, as well as the longer-term effects of foot orthoses on lower limb biomechanics, are yet to be determined.