Influence of patellofemoral pain syndrome on plantar pressure in the foot rollover process during gait

BACKGROUND: Patellofemoral Pain Syndrome is one of the most common knee disorders among physically active young women. Despite its high incidence, the multifactorial etiology of this disorder is not fully understood. OBJECTIVES: To investigate the influence of Patellofemoral Pain Syndrome on plantar pressure distribution during the foot rollover process (i.e., the initial heel contact, midstance and propulsion phases) of the gait. MATERIALS AND METHODS: Fifty-seven young adults, including 22 subjects with Patellofemoral Pain Syndrome (30 ± 7 years, 165 ± 9 cm, 63 ± 12 kg) and 35 control subjects (29 ± 7 years, 164 ± 8 cm, 60 ± 11 kg), volunteered for the study. The contact area and peak pressure were evaluated using the Pedar-X system (Novel, Germany) synchronized with ankle sagittal kinematics. RESULTS: Subjects with Patellofemoral Pain Syndrome showed a larger contact area over the medial (p = 0.004) and central (p = 0.002) rearfoot at the initial contact phase and a lower peak pressure over the medial forefoot (p = 0.033) during propulsion when compared with control subjects. CONCLUSIONS: Patellofemoral Pain Syndrome is related to a foot rollover pattern that is medially directed at the rearfoot during initial heel contact and laterally directed at the forefoot during propulsion. These detected alterations in the foot rollover process during gait may be used to develop clinical interventions using insoles, taping and therapeutic exercise to rehabilitate this dysfunction.

[1]  V. Macellari,et al.  Multistep pressure platform as a stand-alone system for gait assessment , 1996, Medical and Biological Engineering and Computing.

[2]  R. Shephard.  Limits to the measurement of habitual physical activity by questionnaires , 2003, British journal of sports medicine.

[3]  P. Cavanagh,et al.  Clinical plantar pressure measurement in diabetes: rationale and methodology , 1994 .

[4]  V. Macellari,et al.  Spatial-temporal parameters of gait: reference data and a statistical method for normality assessment. , 1999, Gait & posture.

[5]  Hongwei Hsiao,et al.  Accuracy and precision of two in-shoe pressure measurement systems , 2002, Ergonomics.

[6]  K. Dehaven,et al.  Athletic injuries: Comparison by age, sport, and gender , 1986, The American journal of sports medicine.

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

[8]  J. Perry,et al.  The influence of walking speed and footwear on plantar pressures in older adults. , 2004, Clinical biomechanics.

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

[10]  W. Perman,et al.  Patellofemoral joint contact area is influenced by tibiofemoral rotation alignment in individuals who have patellofemoral pain. , 2007, The Journal of orthopaedic and sports physical therapy.

[11]  N. Breslow,et al.  Statistical methods in cancer research: volume 1- The analysis of case-control studies , 1980 .

[12]  M. T. Gross,et al.  The role of foot orthoses as an intervention for patellofemoral pain. , 2003, The Journal of orthopaedic and sports physical therapy.

[13]  Wendy Gilleard,et al.  Tibia and rearfoot motion and ground reaction forces in subjects with patellofemoral pain syndrome during walking. , 2007, Gait & posture.

[14]  Christopher M Powers,et al.  Comparison of Foot Pronation and Lower Extremity Rotation in Persons With and Without Patellofemoral Pain , 2002, Foot & ankle international.

[15]  A. Marques,et al.  Functional and EMG responses to a physical therapy treatment in patellofemoral syndrome patients. , 2006, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[16]  P Kannus,et al.  Which factors predict the long-term outcome in chronic patellofemoral pain syndrome? A 7-yr prospective follow-up study. , 1998, Medicine and science in sports and exercise.

[17]  I. Davis,et al.  Patellofemoral pain syndrome: proximal, distal, and local factors, an international retreat, April 30-May 2, 2009, Fells Point, Baltimore, MD. , 2010, The Journal of orthopaedic and sports physical therapy.

[18]  J. A. Robinson.  Clinics , 1883, The Dental register.

[19]  M R Pierrynowski,et al.  The effect of soft foot orthotics on three-dimensional lower-limb kinematics during walking and running. , 1994, Physical therapy.

[20]  I. Sacco,et al.  Medial contact and smaller plantar loads characterize individuals with Patellofemoral Pain Syndrome during stair descent. , 2010, Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine.

[21]  E. Hennig,et al.  Plantar Pressure Distribution Patterns During Gait in Diabetic Neuropathy Patients with a History of Foot Ulcers , 2009, Clinics.

[22]  D. De Clercq,et al.  A prospective study of gait related risk factors for exercise-related lower leg pain. , 2006, Gait & posture.

[23]  P. Levinger,et al.  The heel strike transient during walking in subjects with patellofemoral pain syndrome , 2005 .

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

[25]  John D. Childs,et al.  Associates of physical function and pain in patients with patellofemoral pain syndrome. , 2009, Archives of physical medicine and rehabilitation.

[26]  J. Hertel,et al.  Patterns of Dynamic Malalignment, Muscle Activation, Joint Motion, and Patellofemoral-Pain Syndrome , 2005 .

[27]  Dirk De Clercq,et al.  A Prospective Study on Gait-related Intrinsic Risk Factors for Patellofemoral Pain , 2007, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[28]  B. Nigg,et al.  The effect of changes in foot sensation on plantar pressure and muscle activity. , 2001, Clinical biomechanics.

[29]  C. Powers.  The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. , 2010, The Journal of orthopaedic and sports physical therapy.

[30]  C. M. Siqueira,et al.  Can Quiet Standing Posture Predict Compensatory Postural Adjustment? , 2009, Clinics.

[31]  C. Powers.  The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. , 2003, The Journal of orthopaedic and sports physical therapy.

[32]  J. Greve,et al.  Comparison of Radial Shockwaves and Conventional Physiotherapy for Treating Plantar Fasciitis , 2009, Clinics.

[33]  Cynthia LaBella,et al.  Patellofemoral pain syndrome: evaluation and treatment. , 2004, Primary care.

[34]  P. Cavanagh,et al.  The arch index: a useful measure from footprints. , 1987, Journal of biomechanics.

[35]  J. Shaw,et al.  An analysis of dynamic forces transmitted through the foot in diabetic neuropathy. , 1998, Diabetes care.