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If the Shoe Orthotic Fits, Wear It

The purpose of this study was to look at the effects of a custom shoe insert (called an orthotic) on knee pain. More specifically, the use of a foot orthotic for kneecap pain was evaluated. Knee pain, stiffness, and physical function were used to measure the success of the orthotic.

The idea behind using a foot orthotic is that it helps support the foot in the middle. The arch of the foot is kept from dropping down into a flat-footed position called pronation. Too much pronation can cause rotation inward of the lower leg bone (the tibia). This rotation pushes the kneecap off-center. Knee pain may develop when the kneecap doesn't track up and down properly.

Sixteen people between the ages of 14 and 50 were part of the study. All had at least two months of knee pain and too much forefoot pronation. Everyone filled out a special form called the WOMAC. This is a group of 24 questions answered by each patient about their symptoms and function. Results of the WOMAC help decide if the orthotic is working.

Each patient was fitted with an orthotic made just for him or her. The insert was heated and molded to the foot to hold the rearfoot in a midline position. Two weeks after getting the foot orthotic, each patient filled out the WOMAC again. The WOMAC was completed a third time three months after they began using the orthotic.

The authors report that all WOMAC scores were much better after three months of using the orthotic. They conclude that custom-made foot orthoses can help patients with kneecap pain when there's too much foot pronation. Pain, stiffness, and physical function were all improved with this treatment.

References: Lisa B. Johnston, PT, MS, and Michael T. Gross, PT, PhD. Effects of Foot Orthoses on Quality of Life for Individuals with Patellofemoral Pain Syndrome. In Journal of Orthopaedic & Sports Physical Therapy. August 2004. Vol. 34. No. 8. Pp. 440-448.

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