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Project

Dose-response effect of computer-aided design foot orthoses on foot and lower limb biomechanics of patients with patellofemoral pain.

Patellofemoral pain (PFP) is very prevalent amongst the general population (23%) and even more in certain sport activities (up to 35% in elite cycling). The aetiology is thought to be a “complex interplay among various anatomical, biomechanical, psychological, social and behavioural influences”. A recent paper summarised the biomechanical factors that could lead to an elevated patellofemoral joint loading and supposedly to patellofemoral pain. In addition to a number of proximal deficits (e.g. altered trunk and hip kinematics, impaired quadriceps function), altered foot mechanics appeared to be a potential contributing factor (i.e. subtalar joint pronation resulting in more tibial internal rotation through coupling mechanisms). As a consistent result with this potential aetiology, the latest guidelines seems to confirm the effectiveness of foot orthoses (FO) for PFP treatment. However, this effectiveness was suboptimal since evidence also showed a large amount of non-responders to FO, just as the treatment encompassing hip exercices. Reasons for these suboptimal outcomes may be associated with several factors. Firstly, studies performed hitherto did not consider subgroups of patients in their PFP population. However, this is an emerging phenomenon in the literature. In fact, growing evidence suggests that proximal deficits may dominate in some PFP subjects, and distal deficits in others. Secondly, the distal component (foot and ankle biomechanics) has mainly been studied throughout the application of one-segment foot models. Unfortunately, these models do not present an accurate picture of its 33 joints complexity. The use of multi-segment kinematic and kinetic foot models could overcome these limitations. Finally, the critical appraisal of FO approaches used in previous studies highlights that adequate dosage-response modelling is lacking, since appropriate digital design and manufacturing processes were not included. The current PhD project will address the aforementioned shortcomings by developing, in a first instance, various methodological optimisations in the field of FO research. In a second stage, a RCT will study the influence of these optimisations on the lower limb biomechanics of PFP patients facing dominantly distal deficits.

Date:12 Jun 2020 →  Today
Keywords:Podiatry, Podiatric medicine, Foot orthoses, 3D foot model, Foot biomechanics, Lower limb biomechanics, Patellofemoral pain
Disciplines:Biomechanics, Rehabilitation sciences, Musculo-skeletal systems, Pathophysiology, Sports sciences
Project type:PhD project