Author Names
Kim, H. J., Cho, J., & Lee, S.
Reviewer Name
Timothy Chang, SPT
Reviewer Affiliation(s)
Duke University, School of Medicine, Physical Therapy Department
Paper Abstract
Background Patellofemoral pain syndrome (PFPS) is defined as pain around the patella while performing activities such as squats, running, and climbing steps. One of the inherent risk factors for PFPS is an excessively pronated foot posture. The aim of this study was to investigate the effect of foot intervention, talonavicular joint mobilization (TJM) and foot core strengthening (FCS), on PFPS. Methods Forty-eight patients with PFPS (mean age, 21.96 ± 2.34 years; BMI, 22.77 ± 2.95 kg/m2) were enrolled in the study. Participants were randomly assigned in a 1:1:1 ratio to three groups, and received 12 sessions of TJM, FCS, and blended intervention at university laboratory for 4 weeks. The primary outcomes were pain while the secondary outcomes were lower extremity function, valgus knee, foot posture, and muscle activity ratio measured at baseline, after 12 sessions, and at the 4-week follow-up. Results The two-way repeated-measures ANOVA revealed significant interactions in all groups (p < 0.05). TJM reduced pain more than the FCS at post-test (mean difference, − 0.938; 95% Confidence interval [CI], − 1.664 to − 0.211; p < 0.05), and blended intervention improved lower extremity function (mean difference, 6.250; 95% CI, 1.265 to 11.235; p < 0.05) and valgus knee (mean difference, − 11.019; 95% CI, − 17.007 to − 5.031; p < 0.05) more than the TJM at 4 weeks follow-up. TJM was more effective in post-test (mean difference, − 1.250; 95% CI, − 2.195 to − 0.305; p < 0.05), and TJM (mean difference, − 1.563; 95% CI, − 2.640 to − 0.485; p < 0.05) and blended intervention (mean difference, − 1.500; 95% CI, − 2.578 to − 0.422; p < 0.05) were more effective in foot posture than the FCS in 4 weeks follow-up. Blended intervention displayed greater improvement in muscle activity than the TJM (mean difference, 0.284; 95% CI, 0.069 to 0.500; p < 0.05) and the FCS (mean difference, 0.265; 95% CI, 0.050 to 0.481; p < 0.05) at 4 weeks follow-up. Conclusions Our study is a novel approach to the potential impact of foot interventions on patellofemoral pain. Foot intervention including TJM and FCS is effective for pain control and function improvement in individuals with PFPS.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- No
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- No
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Cannot Determine, Not Reported, or Not Applicable
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- No
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- No
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Results suggested that talonavicular joint mobilization is effective for immediate control of patellofemoral pain and foot posture. The mobilization can help activate the muscles around the joints because of stimulation to the mechanorecptors in the joint and muscles.
Key Finding #2
Blended intervention has a positive effect on dynamic knee valgus, increased vastus medialis muscle activity compared to vastus lateralis and controlled pain.
Please provide your summary of the paper
This was a single blind, three group, parallel arm, randomized controlled trial with three evaluation sessions at basline, post-test, and four week follow up with a 4 week intervention. The three groups included a talonavicular joint mobilization, foot core strengthening, and a blended intervention group. It was found that talonavicular joint mobilization is effective for immediate control of patellofemoral pain and foot posture. Additionally, the blended intervention had a positive effect on the knee’s biomechanics and muscle activity of the quadriceps.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This article suggests that clinicians can consider incorporating talonavicular joint mobilization into treatment plans for patients with patellofemoral pain. It also highlights the importance of considering joint and muscle receptor interactions in the management of lower extremity conditions. Additionally, the use of comprehensive treatment strategies that address both biomechanical alignment and muscle function are supported. Clinicians may use this information to design rehabilitation programs that target muscle imbalances and control pain more effectively, potentially leading to better outcomes for patients with knee-related issues. Lastly, these findings can inform physical therapists and other healthcare professionals in their clinical decision-making, potentially leading to more targeted and effective interventions for patients with patellofemoral pain and related musculoskeletal disorders.
