Sindrome Femoro -rotulea

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Effect of adding short foot exercise to hip and knee focused exercises in treatment of patients with patellofemoral pain: a randomized controlled trial

Patellofemoral pain syndrome (PFPS) is one of the most common knee problems that disturb function and daily activities (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764329/). Symptoms of PFPS can develop either slowly or abruptly, and pain tends to worsen with activities such as squatting, prolonged sitting, stair climbing, jumping, or running (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764329/). PFPS affects approximately 25% of physically active individuals (https://pubmed.ncbi.nlm.nih.gov/26792702/). The development of patellofemoral pain is believed to have multiple contributing factors, including proximal, local, and distal factors (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9909566

).

Kamel and colleagues (https://pubmed.ncbi.nlm.nih.gov/38561773/) examined the effects of adding the short foot exercise to hip and knee focused exercises in 28 male and female (18-35 years) patients with patellofemoral pain (at least 2 painful isometric muscle contraction tests with a slight bent knee, (ii) palpation of the patellofemoral joint line, (iii) patellar compression against the femoral bone, and (iv) active resisted knee extension, https://pubmed.ncbi.nlm.nih.gov/28844333/) and a navicular drop test of more than 10 mm (https://pubmed.ncbi.nlm.nih.gov/34024814/).

Participants received their interventions during 6 consecutive weeks (12 sessions). Pain intensity, function, abductors quadriceps muscle strength, and balance were assessed using the Visual Analog Scale, anterior knee pain scale (AKPS), hand-held dynamometer, and the Biodex Balance System respectively. All measurements were taken before and after 6 weeks of intervention in both grou

s.

To perform the short foot exercise (SFE), participants were A to elevate the medial longitudinal arch (MLA), shorten the foot in the anterior-posterior line, and approximate the first metatarsal head toward the heel without toe flexion (s. picture). The elevated MLA position would be maintained for five seconds in each repetition. Participants performed the SFE in 3 sets of 15 repetitions each day for two days per week for 6 weeks (with at least one day between each session, https://pubmed.ncbi.nlm.nih.gov/34024814/). The participants had to start the exercise in a sitting position (in the first and second weeks) and then progress to a double stance (in the third and fourth weeks), then a single-leg stance position (in the fifth and sixth weeks, https://pubmed.ncbi.nlm.nih.gov/34024814, https://pubmed.ncbi.nlm.nih.gov/30860412/). In addition to the SFE program, the participants in this group received hip and knee focused exercise program, while the participants in the control group received only a hip (side-lying hip abduction, hip external rotation (clamshell), and prone hip extension) and knee focused (supine straight leg raises, supine terminal knee extensions (from 10° flexion to full extension), and a mini-squat (45° flexion)) exercise program.

For the hip and knee focused exercises: the number of repetitions is increased from 3 sets of 10 repetitions to a maximum of 3 sets of 20 repetitions. Thereafter resistance is increased using a weight cuff or resistance tubing. Repetitions were performed dynamically over 2–3 s. 2-second pause between repetitions. 30-second pause between sets for two days per week for six weeks. Minimum one rest day between sessions.

The within-group comparison showed significant improvement in pain severity, function, balance, and hip abductors, and quadriceps muscles strength in both groups post-treatment compared with pre-treatment. Between groups analysis, however, showed a significant statistical difference between both groups in pain (mean difference 2.6 (1.8, 3.4)/10), function (-4 (-7, -1)/100), and mediolateral stability which showed better improvement compared to the control group. All others assessed variables showed no between group differences.

Previous studies have found that individuals with a pronated foot exhibit reduced electromyographic activity in the Abductor Hallucis (AbdH) muscle (https://pubmed.ncbi.nlm.nih.gov/14688773/, https://pubmed.ncbi.nlm.nih.gov/15109760/), which works together with the peroneus longus muscle to support the MLA. A study by Jung et al. (https://pubmed.ncbi.nlm.nih.gov/22142711/) reported a significant increase in the cross-sectional area of the AbdH muscle after performing the SFE exercises with foot orthoses.

The authors speculate that thee SFE can elevate MLA through a closed kinetic chain mechanism, potentially correcting foot pronation and altering foot biomechanics (https://pubmed.ncbi.nlm.nih.gov/28167183/). Moreover, these changes in foot mechanics may have a kinematic impact on the entire lower extremity, potentially reducing internal tibial rotation and hip adduction. This, in turn, may lead to a decrease in internal femoral rotation, thereby reducing lateral compressive forces on the patella. This can be beneficial for improving knee pain (https://pubmed.ncbi.nlm.nih.gov/24359629/, https://pubmed.ncbi.nlm.nih.gov/14669959/, https://pubmed.ncbi.nlm.nih.gov/19996330/).

Results by M?lgaard et al. (https://pubmed.ncbi.nlm.nih.gov/28844333/) corroborated these results, documenting improved knee pain following adding foot-focused exercises and foot orthoses to knee-focused exercise program.

In conclusion, the findings of this study showed that adding SFE to hip and knee exercise improved pain, function, and mediolateral stability in the treatment of patients with PFPS. This can help clinicians improve their treatment program for PFPS patients to achieve better results with them, decrease recurrence rate, and improve disease prognosis.

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