Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females With and Without Patellofemoral Pain Syndrome

Abstract

We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

The effects of medial and lateral wedges on iliotibial band strain during overground running

“…Use of lateral wedges has been shown to increase ankle inversion moments and external knee valgus moments, shifting the loading of the knee to the lateral compartment (Lewinson et al, 2013b). An increase in external knee varus moments and external rotation moments result in greater strain on soft tissues that cross the lateral aspect of the knee and increases loading of the medial knee compartment (Boldt et al, 2013;Maclean et al, 2009;Mundermann et al, 2003). These results suggest that if kinetics play a role in the etiology of ITBS, then medial wedges could be harmful.…”

“…Existing literature indicates the use of medial wedge orthotics can alter kinematic patterns that could be beneficial in prevention and/or rehabilitation of ITBS. However, use of medial wedges may lead to greater knee external varus moments, increasing ITB strain (Boldt et al, 2013;Lewinson et al, 2013a;Maclean et al, 2009;Nigg et al, 2003). Our first hypothesis is that medial wedges will decrease ITB strain rate despite a potential increase in knee varus.…”

“…Joint moments at the ankle and knee are affected by orthotic use. Medially aligned wedges and custom foot orthotics often reduce ankle inversion moments (Lewinson et al, 2013a;Maclean et al, 2009;Nigg et al, 2003;, but increase knee external rotation moments and external knee varus moments, shifting the loading of the knee to the medial compartment (Boldt et al, 2013;Lewinson et al, 2013a;Maclean et al, 2009;Nigg et al, 2003). Use of lateral wedges has been shown to increase ankle inversion moments and external knee valgus moments, shifting the loading of the knee to the lateral compartment (Lewinson et al, 2013b).…”

“…Lower muscle activity would then result in less fatigue and energy expenditure (Nigg et al 1999;Boldt et al, 2013). It has been extensively studied how medial and lateral wedges and various models of custom foot orthotics (CFO's) affect running gait, but results have been inconclusive.…”

“…Varying anatomical alignments or current injuries have the potential to affect the effect of orthotics. Boldt et al (2013) examined females with and without patellofemoral pain syndrome (PFPS) running with a full foot 6° medial wedge.…”