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Randomized Controlled Trial
. 2025 Aug 28;15(1):31687.
doi: 10.1038/s41598-025-17000-6.

Effects of altering walking foot strike pattern in combination with lower extremity strengthening on lower limb alignment in females with patellofemoral pain: a randomized controlled trial

Ali Yalfani  1 , Fatemeh Ahadi  2 , Mohamadreza Ahmadi  2
Affiliations
Randomized Controlled Trial

Effects of altering walking foot strike pattern in combination with lower extremity strengthening on lower limb alignment in females with patellofemoral pain: a randomized controlled trial

Ali Yalfani et al. Sci Rep. .

Abstract

Background: Rear-foot eversion increases the patellofemoral joint stress through the mechanism of lower extremity coupling. Therefore, the present clinical trial aimed to evaluate the effects of altering walking foot strike pattern in combination with lower extremity strengthening on lower limb alignment in females with patellofemoral pain (PFP).

Methods: Forty women with PFP were randomly assigned to experimental (n = 20) and control groups (n = 20). For 8 weeks, the experimental group received the forefoot strike pattern combined with foot-knee strengthening exercises. Versus, the control group during 8 weeks did not receive any intervention aimed at treating PFP. The primary outcome was self-reported pain. The secondary outcome was rear-foot eversion, dynamic knee valgus (DKV), pelvic drop, hip extensor, hip abductor, and knee extensor muscle strength, which were measured before and after 8 weeks. Covariance analysis was used to compare the results between the two groups.

Results: A significant difference was observed in reduced pain (P < 0.001, η2 = 0.884), rear-foot eversion (P < 0.001, η2 = 0.880), DKV (P < 0.001, η2 = 0.740), and pelvic drop (P < 0.001, η2 = 0.540). In addition, a significant difference was observed in the increase in the muscle strength of the hip extensor (P < 0.001, η2 = 0.743), hip abductor (P < 0.001, η2 = 0.770), and knee extensor (P < 0.001, η2 = 0.811).

Conclusion: Eight weeks the lower limb strengthening and changes in foot strike during walking can have clinical importance in reducing self-reported pain, rear-foot eversion, DKV, and pelvic drop during a single leg squat.

Keywords: Education; Foot; Kinematic; Patellofemoral pain; Rehabilitation.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The present clinical trial was approved by the ethics committee of Bu-Ali Sina University (R.BASU.REC.1402.012). The trial was registered in the Clinical Trials Registry Iran (IRCT20230425057991N1) on 08/06/2023. All methods were performed in accordance with the relevant guidelines and regulations. Also, this study was adhered to the ethical principles of the 2013 Declaration of Helsinki. Consent for publication: Not applicable.

Figures

Fig. 1
Fig. 1
Angles measure of A) rear-foot eversion, B) dynamic knee valgus, C) pelvic drop during a single-leg squat.
Fig. 2
Fig. 2
CONSORT flowchart shows the process of patient selection and group allocation.
Fig. 3
Fig. 3
Line graph depicts of variables of interest over time for both groups.
Fig. 4
Fig. 4
Comparison of pre and post-test data for primary (rear-foot eversion) and secondary outcome (self-reported pain, dynamic knee valgus, pelvic drop, muscles strength of hip extensor, hip abductor, and knee extensor). *, Significant difference between group (P < 0.05).
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