Kinematic Effects of Sensorimotor Foot Orthoses on the Gait of Patients with Patellofemoral Pain -A Randomized Controlled Trial

Steven Simon^*Jonas Dully^*Oliver LudwigCarlo DindorfEva BartaguizMichael FröhlichStephan Becker

• Technical University of Kaiserslautern, Kaiserslautern, Germany

Foot orthoses (FOs) are a noninvasive and cost-effective medical treatment that positively influence biomechanical factors, such as the kinematics of the lower extremities. Nevertheless, there is a research gap regarding the influence of FOs, particularly sensorimotor foot orthoses (SMFOs), on joint kinematics of the lower extremity in gait. Therefore, this randomized controlled clinical trial addressed the impact of SMFOs on the ankle, knee, and hip joint kinematics of patients with patellofemoral pain (PFP) in comparison to that of biomechanical foot orthoses (BMFOs). A total of 20 participants (6 men; 14 women) were part of a three-month intervention with stratified random assignment to custom-made SMFO or BMFO treatment. In the pre-and post-tests, three 12-meter gait walks were assessed by inertial measurement units (IMUs) with the patients wearing no FOs, SMFOs, and BMFOs. For each joint in all three dimensions, three-way repeated-measures statistical parametric mapping (SPM) was performed using analysis of variance (ANOVA)-like statistics. Posthoc, the significant results were checked using post-hoc t-test-like SPMs. Results show that SMFOs and BMFOs both significantly changed ankle and knee kinematic parameters in patients with PFP in long-term. No significant immediate effects of FOs were detected; however, there were significant interaction effects between the time of measurement and the groups. In the pre-post comparison, the SMFO-treated group showed less dorsiflexion in the initial contact and terminal stance, less knee flexion in the mid stance, terminal stance, and pre-swing, as well as a more neutral knee movement in the frontal plane. The BMFO-treated group showed slightly more knee abduction in the terminal stance, greater knee flexion at initial contact, and less hip adduction at initial contact. Overall, the results of this trial support the assumption that temporal adaptation processes play a vital role in the application of custom-made orthopedic FOs and highlight the long-term effects on the kinematics of the lower extremities.Therefore, the authors addressed the following research question: Does wearing custom-made SMFOs alter the kinematics of the ankle, knee, and hip in patients' gait in the short-(immediate) and long-term (three months) differently from custom-made BMFOs?