RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
05/04/2012
RE: Recent Research Confirms Therapeutic Effect of Foot Orthoses for Anterior Knee Pain (Jeff Root)
From: Robert Bijak, DPM, Kevin A. Kirby, DPM
As the writer of one of the two letters that Mr. Root referenced, I must take issue with his statement, "We must all accept the limitations of the research environment." We must NEVER accept a poorly constructed study, and must discard its conclusions. There are enough myths in podiatric biomechanics and orthotic theory already. Observer bias is one type of study error, and Mr. Root has a well-known bias in the area of shoe inserts.
Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com
As Jeff Root very clearly stated, the research study on anterior knee pain (i.e. patellofemoral syndrome), which I posted on PM News a few days ago, prospectively investigated the therapeutic effects of foot orthoses versus no treatment over a six week treatment period. The orthoses used were over-the-counter (OTC) orthoses and showed a significant effect in reducing the knee pain with 79% of the subjects who received these OTC orthoses (Mills K, et al., 2011).
Certainly, it seems plausible if OTC orthoses can have this much therapeutic effect for the treatment of patellofemoral syndrome by presumably altering the kinetics and kinematics of the foot and lower extremity, then the judicious use of prescription foot orthoses made with modifications such as inverted balancing position, well-formed medial arch, medial heel skive, and varus forefoot extensions will have an even greater potential to relieve the pain from patellofemoral syndrome by more specifically altering the kinetics and kinematics of the foot and lower extremity in order to address the abnormal biomechanics that result in this condition.
Unfortunately, at this time, no research studies have compared the therapeutic efficacy of OTC to custom foot orthoses for the treatment of patellofemoral syndrome. However, in my clinical experience and that of many other sports podiatrists who routinely treat cases of patellofemoral syndrome in running and jumping athletes, specially modified prescription foot orthoses are quite effective, along with hip and thigh strengthening exercises, in successfully treating this painful and disabling condition.
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
