Foot Core Training Plus Hip And Knee Strengthening For Patellofemoral Pain

Key Takeaways

• Adding foot-core training to hip–knee strengthening was associated with greater post-intervention pain reduction and higher function scores than hip–knee strengthening alone.
• The experimental group showed lower hip adduction and knee valgus, greater ankle dorsiflexion during step-down, and higher quadriceps and hip abductor torque.
• Authors described the added pain and function gains as small, and they said the clinical significance of the biomechanical changes needs further study.

Adding foot-core training to hip–knee strengthening over 6 weeks was associated with greater post-intervention pain reduction than strengthening alone in patellofemoral pain (P=0.022; ηp²=0.135). The assessor-blinded randomized comparison included 40 participants. Both groups received hip–knee strengthening, while the experimental group also completed foot-core training. Function scores were also higher after the combined program. Selected kinematic and strength outcomes differed between groups at post-intervention.

Forty participants with patellofemoral pain were randomized to foot-core plus hip–knee strengthening or hip–knee strengthening alone for 6 weeks in this assessor-blinded randomized controlled trial. Outcomes were measured at baseline and immediately after the intervention. The primary endpoint was worst pain during daily activities on a visual analog scale. Secondary measures included function on the Anterior Knee Pain Scale and concentric isokinetic relative peak torque at 60°/s during hip and knee testing of the affected limb. Three-dimensional hip, knee, and ankle angles during the single-leg step-down task were also assessed; mean ages were 23.89 and 22.94 years.

After treatment, function scores on the Anterior Knee Pain Scale were higher in the experimental group than in control (P=0.001; ηp²=0.257). The experimental group also had a greater reduction in worst pain during daily activities than control. Both between-group differences were observed at the immediate post-intervention assessment. Assessments ended after the 6-week intervention. The authors described the added foot-core program as producing small additional gains in pain and function.

During the single-leg step-down task, the experimental group had lower hip adduction (P<0.001; ηp²=0.676) and lower knee valgus (P<0.001; ηp²=0.525). Greater ankle dorsiflexion was also observed after the intervention (P<0.001; ηp²=0.805). Quadriceps relative peak torque (P<0.001; ηp²=0.669) and hip abductor relative peak torque (P<0.001; ηp²=0.594) were higher in the experimental group. Hamstrings and hip extensors did not differ between groups, with P values of at least 0.398. These findings were limited to selected post-intervention movement and strength measures.

The authors concluded that adding foot-core training to hip–knee strengthening produced small additional improvements in pain and function. Larger between-group effects were also reported in selected kinematic variables and measured strength outcomes. The clinical significance of the biomechanical changes still requires further investigation. Published on 30 April 2026, the study assessed outcomes immediately after the 6-week intervention. Overall, the trial showed short-term between-group differences across symptoms, function, and selected movement and strength measures in patellofemoral pain.