1. FOOT ORTHOSESFOR THETREATMENT OFPATELLOFEMORALJOINT PAINIsaac KnottStudent ID: u3068884

2. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN Prevalence = approximately26% active population [1]. Pain in retro-patellar (behind)or peri-patella (around) [1]. Pain brought on through anincreased load through thepatellofemoral joint [1-3]. Prolonged walking,ascending/descending stairs,running, kneeling, squatting,prolonged sittingImage 1: Moveforwardpt.com. Patellofemoral Pain - MoveForwardPT.com [Internet]. 2014 [cited 14 September 2014]. Available from: http://www.moveforwardpt.com/symptomsconditionsdetail 3. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINImage 2: My Trainer Chris. Knee Strengthening for Females [Internet]. 2013 [cited 14 September 2014]. Available from:http://mytrainerchris.wordpress.com/2013/12/21/knee-strengthening-for-females/ 4. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINConservative management iscurrently considered the principletreatment, with foot orthoses oftenprescribed in combination or as analternative to other managementstrategies including taping, exerciseprescription and analgesics(2). 5. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN Foot orthoses are specially mouldeddevices designed to fit inside footwear (1). Many different variations and styles Custom vs prefabricated Hard, medium or soft Corrects foot posture and improveslower limb biomechanics therebydecreasing PFJ pain? (1,3)Image 3 & 4: Soleplatinum.blogspot.com.au. Sole Solutions: Custom Foot Orthotics Laboratory in Cayman! [Internet]. 2011 [cited 14 September 2014]. Available from:http://soleplatinum.blogspot.com.au/2011/06/custom-foot-orthotics-laboratory-in.html 6. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINWhy is it important? High prevalence Decreases functional performance Potential to contribute to additional chronic conditions (e.gosteoarthritis) Physiotherapists on the frontline in terms of treating suchconditions Orthotics widely available 7. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN 8. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN 9. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN 10. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINEvaluationStrengths Clearly defined research question. Extensive search for relevantpapers using strict inclusion andexclusion criteria. Methods for each of the includedtrials were evaluated for bias. Results interpreted withappropriate applications forclinical practice. Protocols implemented to reducethe risk of bias through theselection and review process.Weaknesses Only two articles wereexamined Prevented assessments ofheterogeneity and sensitivity Neither of the reviewed trialshad a clearly defined controlgroup. 11. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN 12. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN 13. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINEvaluationStrengths Systematic review did includesome RCTs Larger number of studies andparticipantsWeaknesses Broad and multifacetedresearch question Included case series and otherlower quality study designs Poor study design, poorlydefined outcome measures anda lack of quantifiable data fromthe included studies. Little to no comparisonbetween studies High risk of bias in includedstudies No clear conclusions drawn 14. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN 15. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAIN 16. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINEvaluationStrengths Clearly defined control Clear conclusion drawn Well-designed methods thatattempted to limit possiblesources of bias (e.g. Blinding)Weaknesses Low participant numbers Shorter duration (6wks) Orthoses supplied byprominent internationalmanufacturer. Bias? 17. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINSummary Evidence around this topic seems to be conflicting Higher levels of evidence seem to indicate that orthoses have little impact on PFJpain over the long-term but there is a potentially a positive impact over the shortterm.Clear that there is a lack of high quality, welldesigned trials addressing this topic. 18. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINWhat did I learn? Patience. How to better recognise good quality evidence. A better ability to recognise potential sources of bias. The ability to recognise the clinical significance andpotential impact of a good quality article. 19. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINThank you!Any Questions ?Email: Zacknott@gmail.com 20. FOOT ORTHOSES FOR THETREATMENT OFPATELLOFEMORAL JOINT PAINReferences1.Hossain M, Alexander P, Burls A, Jobanputra P. Foot orthoses forpatellofemoral pain in adults. Cochrane Database Syst Rev. 2011;1.2.Barton MCJ, Munteanu SE, Menz HB, Crossley KM. The efficacy of footorthoses in the treatment of individuals with patellofemoral painsyndrome. Sports Medicine. 2010;40(5):377-95.3.Mills K, Blanch P, Dev P, Martin M, Vicenzino B. A randomised controltrial of short term efficacy of in-shoe foot orthoses compared with a waitand see policy for anterior knee pain and the role of foot mobility. BritishJournal of Sports Medicine. 2011:bjsports-2011-090204.4.Nhmrc.gov.au. Resources for guideline developers | National Healthand Medical Research Council [Internet]. 2014 [cited 14 September2014]. Available from: https://www.nhmrc.gov.au/guidelines/resources-guideline-developers