Associations of foot and ankle characteristics with knee symptoms and function in individuals with patellofemoral osteoarthritis

Abstract

Background Foot and ankle characteristics are associated with patellofemoral pain (PFP) and may also relate to patellofemoral osteoarthritis (PFOA). A greater understanding of these characteristics and PFOA, could help to identify effective targeted treatments. Objectives To determine whether foot and ankle characteristics are associated with knee symptoms and function in individuals with PFOA. Methods For this cross-sectional study we measured weightbearing ankle dorsiflexion range of motion, foot posture (via the Foot Posture Index [FPI]), and midfoot mobility (via the Foot Measurement Platform), and obtained patient-reported outcomes for knee symptoms and function (100 mm visual analogue scales, Anterior Knee Pain Scale [AKPS], Knee injury and Osteoarthritis Outcome Score, repeated single step-ups and double-leg sit-to-stand to knee pain onset). Pearson’s r with significance set at p < 0.05 was used to determine the association between foot and ankle charateristics, with knee symptoms and function, adjusting for age. Results 188 participants (126 [67%] women, mean [SD] age of 59.9 [7.1] years, BMI 29.3 [5.6] kg/m2) with symptomatic PFOA were included in this study. Lower weightbearing ankle dorsiflexion range of motion had a small significant association with higher average knee pain (partial r = − 0.272, p < 0.001) and maximum knee pain during stair ambulation (partial r = − 0.164, p = 0.028), and lower scores on the AKPS (indicative of greater disability; partial r = 0.151, p = 0.042). Higher FPI scores (indicating a more pronated foot posture) and greater midfoot mobility (foot mobility magnitude) were significantly associated with fewer repeated single step-ups (partial r = − 0.181, p = 0.023 and partial r = − 0.197, p = 0.009, respectively) and double-leg sit-to-stands (partial r = − 0.202, p = 0.022 and partial r = − 0.169, p = 0.045, respectively) to knee pain onset, although the magnitude of these relationships was small. The amount of variance in knee pain and disability explained by the foot and ankle characteristics was small (R2-squared 2 to 8%). Conclusions Lower weightbearing ankle dorsiflexion range of motion, a more pronated foot posture, and greater midfoot mobility demonstrated small associations with worse knee pain and greater disability in individuals with PFOA. Given the small magnitude of these relationships, it is unlikely that interventions aimed solely at addressing foot and ankle mobility will have substantial effects on knee symptoms and function in this population. Trial registration The RCT was prospectively registered on 15 March 2017 with the Australia and New Zealand Clinical Trials Registry (ANZCTRN12617000385347).

Current Physiotherapy Approaches for Patellofemoral Pain Syndrome: A systematic review

“…Therapeutic exercise in physiotherapy is effective in seven studies (Tan et al, 2020;Nielsen et al, 2020;Chang et al, 2015;Lee et al, 2021;Faisal Chevidikunnan et al, 2016;de Oliveira Silva et al, 2019) which all the results show consistent findings with Willy et al, (2019). It is agreeable that therapeutic exercises can improve muscle strength and reduce pain in PFPS.…”

“…2.1 Physiotherapy management 2.1.1 Therapeutic Exercise in the Rehabilitation of PFPS Tan et al (2020) found that decreased weight-bearing ankle dorsiflexion range increased knee pain, Anterior Knee Pain Score (AKPS), and maximum knee pain during stair ambulation, worsening disability. Although minor, higher Foot Posture Index (FPI) scores imply overly pronated foot posture and midfoot mobility connected to fewer single step-ups and double-leg sit-to-stands to knee discomfort.…”

“…This hypothesis suggests improving foot position to prevent knee pain and disability. Capin & Snyder-Mackler (2018) and Nielsen et al (2020) disagreed with Tan (2020) and recommended open and closed kinetic chain exercises for hip and knee strengthening in physiotherapy. Nielsen et al (2020) advise physiotherapists to provide 18-year-olds gluteus medius and hamstring workouts.…”

“…Eleven studies show that combined therapies improve pain and physical function, and all demonstrated how to improve PFPS (Tan et al, 2020;Nielsen et al, 2020;Chang et al, 2015;Lee et al, 2021;Chevidikunnan et al, 2016;Ma et al, 2020;Giles et al, 2017;Schwiete et al, 2021;Yañez-Álvarez et al, 2020;Barber et al, 2022;de Oliveira Silva et al, 2019). 5.2.2 Strengthening exercises.…”

Relação entre a baixa mobilidade de tornozelo e as lesões no joelho: Uma revisão sistemática

“…A variação nas respostas individuais sublinha a necessidade de estratégias terapêuticas adaptativas e individualizadas para otimizar a amplitude de movimento. Tan et al (2020), ao analisar características específicas do pé e do tornozelo em relação a sintomas e função do joelho, destaca a modesta explicação da variação na dor e incapacidade no joelho por essas características. Este resultado sugere que, embora importantes, as características do pé e tornozelo podem explicar apenas uma fração da complexidade envolvida nas disfunções articulares relacionadas ao joelho.…”