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Review
. 2022 Apr 17;11(8):2245.
doi: 10.3390/jcm11082245.

Does the Foot and Ankle Alignment Impact the Patellofemoral Pain Syndrome? A Systematic Review and Meta-Analysis

Nicolò Martinelli  1 , Alberto Nicolò Bergamini  2 , Arne Burssens  3 , Filippo Toschi  1 , Gino M M J Kerkhoffs  4 , Jan Victor  3 , Valerio Sansone  1   2
Affiliations
Review

Does the Foot and Ankle Alignment Impact the Patellofemoral Pain Syndrome? A Systematic Review and Meta-Analysis

Nicolò Martinelli et al. J Clin Med. .

Abstract

Background: A convincing association between the foot and ankle alignment (FAA) and patellofemoral pain syndrome (PFPS) remains debatable in the literature. Therefore, all studies investigating the role of FAA in patients with PFPS were systematically reviewed.

Methods: A systematic literature search was performed on the databases PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were all studies investigating static and/or dynamic FAA factors and PFPS. Studies with less than 20 patients or with patellofemoral osteoarthritis were excluded. The quality assessment was based on Cochrane study criteria, and the maximum score was set at eight.

Results: Of 2246 articles, only 13 case-control studies were eligible. Considering static FAA factors, two studies found an association with rearfoot eversion and one with rearfoot inversion. While examining dynamic FAA characteristics, one study found an association with rearfoot eversion range of motion and three with gait kinematics. No further associations were reported. The quality assessment mean score was 5.5 (SD = 0.97) corresponding to moderate quality.

Conclusions: In contrast to our expectations, a limited number of studies were founded supporting an association between FAA and PFPS. At present, the quality of the literature is still poor and conflicting, thus the need for further studies to determine any association between FAA and PFPS.

Keywords: alignment; anterior knee pain; hindfoot; kinematics; patellofemoral pain syndrome; rearfoot.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Differences in foot and ankle alignment.
Figure 3
Figure 3
Forest plot.
Figure 4
Figure 4
Lower Limb alignment. This sign (?) has been inserted because the figure is still a theorical explanation of the association between the two phenomenons.
See this image and copyright information in PMC

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