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J Sci Med Sport. 2018 May;21(5):457-461. doi: 10.1016/j.jsams.2017.09.187. Epub 2017 Oct 2.

Gait retraining versus foot orthoses for patellofemoral pain: a pilot randomised clinical trial.

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Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Australia. Electronic address:
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Australia.
School of Health and Rehabilitation Sciences, Physiotherapy, University of Queensland, Australia.



To determine the feasibility of a clinical trial that compares a 6-week, physiotherapist-guided gait retraining program with a foot orthoses intervention in runners with patellofemoral pain.


Pilot randomised controlled trial.


Runners aged 18-40 years with clinically diagnosed patellofemoral pain were randomly allocated to either a 6-week gait retraining intervention of increasing cadence and use of a minimalist shoe or prefabricated foot orthoses. Outcomes at baseline and 12-weeks included recruitment, retention, adherence, adverse events, global improvement, anterior knee pain scale, worst and average pain on a 100mm visual analogue scale.


Of the 16 randomised participants, two withdrew prior to commencing treatment due to non-trial related matters (n=1 from each group) and 14 completed the pilot trial. Minor calf muscle soreness was reported by 3 participants in the gait retraining group while no adverse events were reported in the foot orthoses group. There were no deviations from the treatment protocols. There was a large between-group difference favouring gait retraining at 12-weeks in the anterior knee pain scale and the worst pain in the past week, which was reflected in the number needed-to-treat of 2.


This study supports the feasibility of a trial comparing gait retraining with foot orthoses and provides point estimates of effect that informs the design and planning of a larger clinical trial. It appears that a 6-week gait retraining program has a clinically meaningful effect on runners with patellofemoral pain when compared to an evidence-based treatment of foot orthoses.


Anterior knee pain; Cadence; Foot orthotics; Minimalist shoe; Running gait

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