Der Einfluss von Schuheinlagen auf das patellofemorale Schmerzsyndrom: Eine systematische Literaturanalyse

Zusammenfassung

Hintergrund: Das patellofemorale Schmerzsyndrom (PFSS) ist bei Knieschmerzen die am häufigsten gestellte Diagnose und gilt als ein bekanntes Beschwerdebild, besonders unter jungen, sportlich aktiven Patienten. Die Symptome führen häufig zu einer Einschränkung physischer Aktivitäten, die sowohl in einer Sportunfähigkeit als auch in einer Arbeitsunfähigkeit sowie in der Entstehung folgenreicher Erkrankungen enden können. Es bestehen verschiedene Erklärungsansätze für die Entstehung des Syndroms, woraus sich unterschiedliche Therapieansätze ergeben. Eine veränderte Fußstellung mit Auswirkung auf die Kinematik der unteren Extremität, gilt als ein möglicher Auslöser der Problematik. Aus diesem Grund gilt die Verordnung von Schuheinlagen als ein Therapieansatz.

Ziel: Ziel dieser Arbeit ist, die aktuelle Evidenz zur Behandlung von PFSS mit verschiedenen Schuheinlagen herauszuarbeiten und zu erörtern, welchen Einfluss diese auf das Syndrom haben.

Studiendesign: Systematische Literaturanalyse klinischer (CT) und randomisierter kontrollierter Studien (RCT).

Methode: Eine systematische Literaturrecherche (CT, RCT) in den Datenbanken Medline (PubMed), Cochrane Library und PEDro wurde durchgeführt. Aus den Informationen des Titels und Abstracts wurden die Publikationen hinsichtlich ihrer Relevanz überprüft. Ergänzend dazu wurde eine Handrecherche sowohl in den Referenzlisten der einbezogenen Studien und begleitender Literatur als auch anhand der Pubmed Suchfunktion „Related articles“ durchgeführt.

Ergebnisse: 11 Studien wurden in die Analyse eingeschlossen. Es wurde der Effekt verschiedener Schuheinlagen auf die Schmerzsymptomatik, die Funktion und die Kinematik der unteren Extremität sowie die Muskelaktivierung ausgewählter Muskeln der unteren Extremität untersucht. Signifikante Veränderungen durch verschiedene Schuheinlagen auf die Schmerzsymptomatik und die Funktion konnten festgestellt werden. Bezüglich der Kinematik der unteren Extremität und der Muskelaktivierung ausgewählter Muskeln konnten nur geringe Einflüsse ausgemacht werden.

Schlussfolgerung: Schuheinlagen scheinen ein gutes Hilfsmittel in der Therapie von PFSS zu sein. Schmerzen konnten durch die Interventionen kurz- und langfristig reduziert werden. Die Schuheinlagen zeigten nur geringe Veränderungen bezüglich der Kinematik und der Muskelaktivierung ausgewählter Muskeln der unteren Extremität. Ein Zusammenhang zwischen biomechanischer Wirkung der Schuheinlagen und Schmerzsymptomatik konnte in den analysierten Studien nicht abschließend bestimmt werden.

Abstract

Background: The patellofemoral pain syndrome (PFPS) is one of the most commonly encountered disorders involving the knee. The symptoms often lead to a reduction of physical activities resulting in sport- and job-related disabilities and the potential occurrence of severe disorders. Different theories for the development of the syndrome exist which result in different therapy modalities. A change in foot posture and its effect on lower limb kinematics seem to be one potential risk factor for the development of the syndrome. This leads to the assumption that foot orthoses might be a potential therapy device.

Objectives: The aims of this study were to outline the state of evidence for the treatment of PFPS with foot orthoses and to identify the effect of foot orthoses on PFPS.

Study Design: A systematic review of clinical (CT) and randomized controlled trials (RCT) was undertaken.

Methods: A systematic search for studies (CT, RCT) was conducted using the databases of Medline (PubMed), Cochrane library, and PEDro. The relevance for further analysis of studies was reviewed on the basis of title and abstract. An additional search was undertaken using the reference lists of the included studies and additional literature as well as the PubMed function “related articles”.

Results: 11 studies were included in this analysis. The effect of different types of foot orthoses on pain, function and kinematics of the lower limb and muscle activation of selected lower limb muscles was analysed. Significant effects on pain and function were determined. A slight effect on kinematics of the lower limb and muscle activation of selected lower limb muscles was identified.

Conclusion: Foot orthoses seem to be an effective treatment device in the therapy for PFPS. An immediate and long-term reduction in pain and an improvement of function occurred following the intervention. There was just a slight change in lower limb kinematics and muscle activation of selected lower limb muscles. The relationship between biomechanical effects of orthoses and pain still seems to be unclear.

Schlüsselwörter

patellofemoraler Schmerz - Schuheinlagen - Kinematik - Effektivität - Übersicht

Key words

patellofemoral pain - foot orthoses - kinematics - effectiveness - review

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