An evaluation of the rearfoot posture in individuals with patellofemoral pain syndrome.

Structural abnormalities of the foot may cause abnormal subtalar joint compensatory motion in order to attain normal function of the lower extremity during gait although studies have not been conclusive. Current conflict in the literature may be related to the differing measures focused on the varying protocols and also the absence of a control group in some studies. This study investigated the rearfoot posture including Subtalar Joint Neutral Position (STJN) and Relaxed Calcaneal Standing (RCS) measurements in patellofemoral pain syndrome (PFPS) and healthy subjects. The angle of STJN during non-weight bearing position and the two dimensional (2D) rearfoot RCS posture was measured using a goniometer in 14 healthy females and 13 females with PFPS. The RCS posture was also measured three dimensionally (3D) by attaching external markers to a tibia shell and the calcaneus and videoing with a four-camera three-dimensional motion analysis system. A one way ANOVA was used to assess the differences between the groups. The 2D and 3D RCS were significantly different between the groups (p ≤ 0.001) with mean -0.23° ± 1.35° , 2.52° ± 3.11° for the control group and 2.35° ± 1.4°, 7.02° ± 3.33° for the clinical group respectively. STJN showed a slight rearfoot varus (although significant p = 0.04) in PFPS (-2.20° ± 1.51° ) compared to the control group (-1.00° ± 1.36°). Negative values indicated inversion and positive values indicated eversion. The 2D and 3D RCS showed a significantly more everted posture of the rearfoot for the PFPS group. Subtalar joint varus may contribute to the increased eversion during relaxed standing in the PFPS group. Rearfoot measurements may be an important addition to other clinical measurements taken to explore the underlying aetiology of subjects with PFPS. Key PointsRearfoot posture of PFPS subjects showed a small varus position of Subtalar Joint Neutral and a rearfoot valgus in relaxed standing posture.Relaxed Calcaneal Standing and Subtalar Joint Neutral Position measurements may be an important addition to other clinical measurements taken to explore the underlying aetiology of subjects with PFPS.

[1]  C Foster,et al.  Athletic performance in relation to training load. , 1996, Wisconsin medical journal.

[2]  P. Renström,et al.  Patellofemoral pain syndrome in young women , 1995, Scandinavian journal of medicine & science in sports.

[3]  G W Gray,et al.  Closed versus open kinematic chain measurements of subtalar joint eversion: implications for clinical practice. , 1988, The Journal of orthopaedic and sports physical therapy.

[4]  G. Lac,et al.  Changes in cortisol and testosterone levels and T/C ratio during an endurance competition and recovery. , 2000, The Journal of sports medicine and physical fitness.

[5]  D. Tiberio.  The effect of excessive subtalar joint pronation on patellofemoral mechanics: a theoretical model. , 1987, The Journal of orthopaedic and sports physical therapy.

[6]  G. Lac,et al.  Steroid assays in saliva: a method to detect plasmatic contaminations. , 1993, Archives internationales de physiologie, de biochimie et de biophysique.

[7]  P D Austermuehle.  Common knee injuries in primary care. , 2001, The Nurse practitioner.

[8]  C. Foster,et al.  Monitoring training in athletes with reference to overtraining syndrome. , 1998, Medicine and science in sports and exercise.

[9]  R. Abboud,et al.  Reliabilty of open kinetic chain subtalar joint measurement , 1997 .

[10]  D. Tiberio,et al.  Pathomechanics of structural foot deformities. , 1988, Physical therapy.

[11]  R. Robertson,et al.  Ratings of Perceived Exertion in Active Muscle During High‐Intensity and Low‐Intensity Resistance Exercise , 2002, Journal of strength and conditioning research.

[12]  J. Durnin,et al.  Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 Years , 1974, British Journal of Nutrition.

[13]  M. Hochberg,et al.  The relationship of age and gender to prevalence and pattern of radiographic changes of osteoarthritis of the knee: Data from Caucasian participants in the Baltimore Longitudinal Study of Aging , 1994, Aging.

[14]  P. Renström,et al.  Patellofemoral pain syndrome in young women , 1995, Scandinavian journal of medicine & science in sports.

[15]  K. Kaufman,et al.  The Effect of Foot Structure and Range of Motion on Musculoskeletal Overuse Injuries , 1999, The American journal of sports medicine.

[16]  E S Grood,et al.  A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. , 1983, Journal of biomechanical engineering.

[17]  T. Flynn,et al.  Identification of individuals with patellofemoral pain whose symptoms improved after a combined program of foot orthosis use and modified activity: a preliminary investigation. , 2004, Physical therapy.

[18]  Robert U Newton,et al.  The Effect of Heavy‐ Vs. Light‐Load Jump Squats on the Development of Strength, Power, and Speed , 2002, Journal of strength and conditioning research.

[19]  R Ceci,et al.  A category-ratio perceived exertion scale: relationship to blood and muscle lactates and heart rate. , 1983, Medicine and science in sports and exercise.

[20]  A. Toriola,et al.  Serum cortisol and testosterone levels in conditioned male distance runners and nonathletes after maximal exercise. , 1986, The Journal of sports medicine and physical fitness.

[21]  R. Smith,et al.  Three-dimensional kinematics of the forefoot, rearfoot, and leg without the function of tibialis posterior in comparison with normals during stance phase of walking. , 1999, Clinical biomechanics.

[22]  R F Vining,et al.  The measurement of hormones in saliva: possibilities and pitfalls. , 1987, Journal of steroid biochemistry.

[23]  F Eckstein,et al.  Age-related changes in the morphology and deformational behavior of knee joint cartilage. , 2001, Arthritis and rheumatism.

[24]  T. Asami,et al.  Age-Related Changes in Distribution of Body Weight on Soles of Feet for Selected Actions and Postures , 1997, Perceptual and motor skills.

[25]  Z. Obmiński,et al.  Comparison of the testosterone-to-cortisol ratio values obtained from hormonal assays in saliva and serum. , 1997, The Journal of sports medicine and physical fitness.

[26]  C. Foster,et al.  A New Approach to Monitoring Exercise Training , 2001, Journal of strength and conditioning research.

[27]  A M Walker,et al.  Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. , 1995, Arthritis and rheumatism.

[28]  J. Taunton,et al.  A retrospective case-control analysis of 2002 running injuries , 2002, British journal of sports medicine.

[29]  K. Häkkinen,et al.  Hormonal responses of multiset versus single-set heavy-resistance exercise protocols. , 1997, Canadian journal of applied physiology = Revue canadienne de physiologie appliquee.

[30]  R. Walker,et al.  Salivary steroid assays for assessing variation in endocrine activity. , 1983, Journal of steroid biochemistry.

[31]  R. Donatelli,et al.  Relationship between static and dynamic foot postures in professional baseball players. , 1999, The Journal of orthopaedic and sports physical therapy.

[32]  P. O’Connor,et al.  Influence of short-term cycling on salivary cortisol levels. , 1987, Medicine and science in sports and exercise.

[33]  R. Kretchmar.  Exercise and Sport Science , 1989 .

[34]  R. Robertson,et al.  Standardized Scaling Procedures for Rating Perceived Exertion During Resistance Exercise , 2001, Journal of strength and conditioning research.

[35]  A. Loucks,et al.  Circadian rhythm of cortisol confounds cortisol responses to exercise: implications for future research. , 1995, Journal of applied physiology.

[36]  S. Subotnick,et al.  The Flat Foot. , 1981, The Physician and sportsmedicine.

[37]  R. Donatelli,et al.  Abnormal biomechanics of the foot and ankle. , 1987, The Journal of orthopaedic and sports physical therapy.

[38]  The relationship of abnormal pronation to chondromalacia of the patella in distance runners. , 1979 .

[39]  S. Gordon,et al.  Influence of Resistance Exercise Volume on Serum Growth Hormone and Cortisol Concentrations in Women , 1996 .

[40]  C. Powers,et al.  Rearfoot posture in subjects with patellofemoral pain. , 1995, The Journal of orthopaedic and sports physical therapy.

[41]  Michael J. Mueller,et al.  Reliability of a diabetic foot evaluation. , 1989, Physical Therapy.

[42]  M. Karamouzis,et al.  Hormonal responses after various resistance exercise protocols. , 2003, Medicine and science in sports and exercise.

[43]  G. Borg.  Borg's Perceived Exertion and Pain Scales , 1998 .

[44]  Noel D. Duncan,et al.  The effect of heavy resistance exercise on the circadian rhythm of salivary testosterone in men , 2001, European Journal of Applied Physiology.

[45]  S. Messier,et al.  Etiologic factors associated with patellofemoral pain in runners. , 1990, Medicine and science in sports and exercise.

[46]  S. Subotnick.  Podiatric Sports Medicine , 1975 .

[47]  Kurt Manal,et al.  A comparison of three-dimensional lower extremity kinematics during running between excessive pronators and normals. , 1998, Clinical biomechanics.

[48]  R A Elveru,et al.  Methods for taking subtalar joint measurements. A clinical report. , 1988, Physical therapy.

[49]  G. Lac,et al.  Saliva Cortisol, Testosterone and T/C Ratio Variations During a Wrestling Competition and During the Post-Competitive Recovery Period , 1999, International journal of sports medicine.

[50]  Johan Bellemans,et al.  Intrinsic Risk Factors for the Development of Anterior Knee Pain in an Athletic Population: A Two-Year Prospective Study * , 2000, The American journal of sports medicine.

[51]  H. Knecht,et al.  A Survey of Foot Types in Normal Females between the Ages of 18 and 30 Years*. , 1988, The Journal of orthopaedic and sports physical therapy.

[52]  J. M. Rothstein,et al.  Goniometric reliability in a clinical setting. Subtalar and ankle joint measurements. , 1988, Physical therapy.

[53]  E. Filaire,et al.  Preliminary results on mood state, salivary testosterone:cortisol ratio and team performance in a professional soccer team , 2001, European Journal of Applied Physiology.

[54]  W J Kraemer,et al.  Acute and chronic hormonal responses to resistance training designed to promote muscle hypertrophy. , 1999, Canadian journal of applied physiology = Revue canadienne de physiologie appliquee.

[55]  T. Craven,et al.  Etiologic factors associated with anterior knee pain in distance runners. , 2000, Medicine and science in sports and exercise.

[56]  M Aström,et al.  Alignment and joint motion in the normal foot. , 1995, The Journal of orthopaedic and sports physical therapy.

[57]  J. Taunton,et al.  A Survey of Overuse Running Injuries. , 1981, The Physician and sportsmedicine.

[58]  M. Caselli,et al.  Reevaluation of the relaxed calcaneal stance position. Reliability and normal values in children and adults. , 1999, Journal of the American Podiatric Medical Association.

[59]  W. Kraemer,et al.  Characteristics of circulating growth hormone in women after acute heavy resistance exercise. , 2001, American journal of physiology. Endocrinology and metabolism.

[60]  K. Muir,et al.  Age and sex differences in hip joint space among asymptomatic subjects without structural change: implications for epidemiologic studies. , 2003, Arthritis & Rheumatism.

[61]  M. Buchbinder,et al.  The relationship of abnormal pronation to chondromalacia of the patella in distance runners. , 1979, Journal of the American Podiatry Association.

[62]  C. Foster,et al.  MONITORING EXERCISE INTENSITY DURING RESISTANCE TRAINING USING THE SESSION RPE SCALE , 2004, Journal of strength and conditioning research.

[63]  Christopher M. Powers,et al.  Practical Management of Patellofemoral Pain , 2002, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[64]  M. Cornwall,et al.  The relationship between static lower extremity measurements and rearfoot motion during walking. , 1996, The Journal of orthopaedic and sports physical therapy.

[65]  R F Vining,et al.  Salivary Cortisol: A Better Measure of Adrenal Cortical Function than Serum Cortisol , 1983, Annals of clinical biochemistry.

[66]  B. Maslen,et al.  Radiographic study of skin displacement errors in the foot and ankle during standing. , 1994, Clinical biomechanics.

[67]  Gunnar Borg,et al.  Perceived exertion related to heart rate and blood lactate during arm and leg exercise , 2004, European Journal of Applied Physiology and Occupational Physiology.

[68]  D. Jacks,et al.  Effect of Exercise at Three Exercise Intensities on Salivary Cortisol , 2002, Journal of strength and conditioning research.

[69]  T G McPoil,et al.  Evaluation and management of foot and ankle disorders: present problems and future directions. , 1995, The Journal of orthopaedic and sports physical therapy.

[70]  H. Raff,et al.  Late-night salivary cortisol as a screening test for Cushing's syndrome. , 1998, The Journal of clinical endocrinology and metabolism.

[71]  M. L. Root,et al.  Normal and abnormal function of the foot , 1977 .

[72]  W. Kraemer,et al.  LH secretion and testosterone concentrations are blunted after resistance exercise in men. , 2001, Journal of applied physiology.

[73]  W. Kraemer,et al.  Relationships Between Serum Testosterone, Cortisol, and Weightlifting Performance , 2000 .

[74]  T. Spector,et al.  Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. , 1999, Arthritis and rheumatism.

[75]  K. Manal,et al.  Comparison of surface mounted markers and attachment methods in estimating tibial rotations during walking: an in vivo study. , 2000, Gait & posture.