Patellofemoral pain syndrome Petersen, Wolf; Ellermann, Andree; Gösele-Koppenburg, Andreas ...
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA,
10/2014, Letnik:
22, Številka:
10
Journal Article
Recenzirano
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The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or ...significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment). Causes for the dynamic valgus may be decreased strength of the hip abductors or abnormal rear-foot eversion with pes pronatus valgus. PFPS is further associated with vastus medialis/vastus lateralis dysbalance, hamstring tightness or iliotibial tract tightness. The literature provides evidence for a multimodal non-operative therapy concept with short-term use of NSAIDs, short-term use of a medially directed tape and exercise programmes with the inclusion of the lower extremity, and hip and trunk muscles. There is also evidence for the use of patellar braces and foot orthosis. A randomized controlled trial has shown that arthroscopy is not the treatment of choice for treatment of PFPS without any structural changes. Patients with anterior knee pain have to be examined carefully with regard to functional causes for a PFPS. The treatment of PFPS patients is non-operative and should address the functional causes.
Level of evidence
V.
We investigated the effects of hindfoot and forefoot eversion on the knee’s positional and rotational displacement, plantar pressure, and foot discomfort in a standing posture, beyond the traditional ...focus on external knee adduction moments (EKAM) in lateral wedge insoles. Twenty-six healthy participants underwent hindfoot eversion from 0 to 10 degrees in 2-degree increments, and forefoot eversion from 0 degrees to the hindfoot eversion angle in 2-degree increments in a standing posture. At each eversion angle, the knee’s medial displacement, EKAM’s moment arm decrease, plantar pressure changes, and foot discomfort were obtained and compared across varying angles. Both hindfoot-only and entire-foot eversion led to significant medial knee displacement and the EKAM’s moment arm decrease, with more pronounced effects in entire-foot eversion. At each hindfoot eversion angle, increasing forefoot eversion resulted in significant medial knee displacement and EKAM’s moment arm decrease. Lower leg rotations were not significantly affected in hindfoot-only eversion but displayed significant medial tilting and internal rotation in entire-foot eversion at specific combinations. Varying eversion angles significantly influenced the forefoot pressure, with heel pressure remaining unaffected. Notably, the lateral forefoot pressure increased significantly as the forefoot eversion angle increased, particularly at higher hindfoot eversion angles. Foot discomfort increased significantly with higher eversion angles, particularly in entire-foot eversion, and also increased significantly as the forefoot eversion angle increased at higher hindfoot eversion angles. Insole configurations incorporating 6–10 degrees of hindfoot eversion and 40–60% forefoot eversion of the hindfoot angle may offer optimized biomechanical support for knee osteoarthritis patients.
Patellofemoral pain in athletes Petersen, Wolf; Rembitzki, Ingo; Liebau, Christian
Open Access Journal of Sports Medicine,
01/2017, Letnik:
8
Journal Article, Book Review
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Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. Most younger patients do not ...have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS). Older patients usually present with signs of patellofemoral osteoarthritis (PFOA). A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs), passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities.
StW 352, from Sterkfontein Member 4 (South Africa), is a partial calcaneus attributed to Australopithecus africanus and is dated to ~2.0–2.6 Ma. The unusual robusticity of the peroneal trochlea (PT) ...of StW 352 has been commented on by several authors. The size of hominin PTs has been hypothesised to be positively correlated with the degree of recruitment of peroneus longus during bipedal locomotion and/ or climbing. Given the potential functional relevance of an enlarged PT for reconstructing hominin activity patterns, we present the following previously unrecognised structural details of the reconstructed StW 352 that affect current interpretations of its functional morphology: (1) we estimate that the PT has been reattached to the body of the calcaneus ~5 mm dorso-distally from its original anatomical position; and (2) the presence of intrusive matrix has artificially misshaped the PT by expanding it laterally and proximodistally. Future studies of this specimen that apply geometric morphometrics, or other shape analysis tools, should compensate for these inaccuracies before undertaking comparisons between it and other calcanei. Additionally, given that the PT is likely smaller than previously reported for StW 352, caution should be exercised when using it to infer muscle function and extrapolate activity patterns of this individual, and thus by extension, within Australopithecus africanus in general. Lastly, these findings highlight the importance of not only the production of accurate reconstructions, but also the critical evaluation of the accuracy of existing reconstructions when working with damaged fossil material. Significance • This work epitomises the value of critically evaluating original fossil reconstructions, especially of postcranial elements. • New technologies (e.g. microCT) offer non-destructive opportunities for evaluating/improving the accuracy of fossil reconstructions. • Re-assessing StW 352 suggests peroneal muscles may have factored less prominently in A. africanus locomotion than previously thought.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction: Proximal and distal factors to the knee joint can be assumed as etiology of patellofemoral pain syndrome (PFPS). Some distal factors include excessive foot pronation and medial tibia ...torsion. The purpose of this study was to compare ankle musculature strength and rearfoot eversion in individuals with and without PFPS. Methods: Forty males (20 healthy and 20 patients) voluntarily participated in this case-control study. Isometric ankle dorsiflexor and invertor muscles strength, rearfoot eversion range of motion (ROM), and Navicular depression were respectively evaluated by handheld dynamometer, goniometry, and Navicular Drop Test by a single examiner for both groups. To analyze the measurements, Independent Samples t test for parametric data and Mann-Whitney U test for nonparametric data at P<0.05 significant level. Results: Isometric ankle dorsiflexor and invertor muscles strength were not statistically significant between the two groups (P>0.05). Furthermore, no significant differences were observed between patients with PFPS and healthy counterparts regarding rearfoot eversion and Navicular depression (P>0.05). Conclusion: It can be deduced that isometric ankle dorsiflexor and invertor muscles strength, rearfoot eversion ROM, and foot pronation are not difference in patients with PFPS and healthy persons.
The purpose of this study was to quantify changes in foot eversion and tibial rotation during running resulting from systematic changes of material composition of five shoe inserts of the same shape.
...Tests were performed with 12 subjects. The inserts had a bilayer design using two different materials at the top and bottom of the insert. The functional kinematic variables examined in this study were the foot-leg in-eversion angle, beta, and the leg-foot tibial rotation, rho. Additionally, the subject characteristics of arch height, relative arch deformation, and active range of motion were quantified. The statistical analysis used was a two way repeated measures MANOVA (within trials and inserts).
The average group changes resulting from the studied inserts in total shoe eversion, total foot eversion, and total internal tibial rotation were typically smaller than 1 degree when compared with the no-insert condition and were statistically not significant. The measured ranges of total foot eversion for all subjects were smallest for the softest and about twice as large for the hardest insert construction. Thus, the soft insert construction was more restrictive, forcing all feet into a similar movement pattern, whereas the harder combinations allowed for more individual variation of foot and leg movement and did not force the foot into a preset movement pattern. The individual results showed substantial differences between subjects and a trend: Subjects who generally showed a reduction of tibial rotation with all tested inserts typically had a flexible foot. However, subjects who generally showed an increase of tibial rotation typically had a stiff foot.
The results of this study suggest that subject specific factors such as static, dynamic, and neuro-physiological characteristics of foot and leg are important to match specific feet and shoe inserts optimally.
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