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

Runners with patellofemoral pain, often called runner's knee, are commonly offered foot orthoses, but researchers wanted to know whether a structured gait retraining program, teaching runners to increase their step rate and switch to a minimalist shoe, might also be a workable option worth testing properly. This pilot trial randomised a small group of runners to either six weeks of gait retraining or prefabricated foot orthoses, mainly to check whether a larger trial would be practical, looking at recruitment, retention, adherence and safety. Fourteen of sixteen participants completed the study, suggesting the design is workable. Pain and knee function scores at 12 weeks pointed toward a larger benefit with gait retraining, but with only a handful of participants in each group, these results are preliminary and meant to guide the design of a bigger study rather than establish which treatment works better.

Some runners doing gait retraining reported minor calf soreness, with none reported in the orthoses group.

If you've dealt with patellofemoral pain, the ache around or behind the kneecap that often flares up with running, you may have been offered shoe inserts (foot orthoses) as a common treatment. This study looked at a different approach: a six-week coaching program that helps runners take quicker, shorter steps and transition to a minimalist shoe, and compared it with foot orthoses. The trial was small, just 16 runners, and was mainly designed to check whether running a bigger study like this was practical, which it appeared to be, since most participants stuck with it through completion.

The early results hinted that the gait retraining group had less pain and better knee function after 12 weeks than the orthoses group, but because so few people took part, these findings are only a preliminary signal, not proof that gait retraining is the better treatment. A few runners in the gait retraining group noticed minor calf soreness, while the orthoses group reported no side effects.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For clinicians weighing gait retraining against foot orthoses for runners with patellofemoral pain, this pilot trial addresses a practical question first: can such a comparison even be run well? With 14 of 16 randomised participants completing the 12-week follow-up, no protocol deviations, and manageable adverse events, the authors conclude the design is feasible for a larger trial. The clinical outcomes, a between-group difference favoring gait retraining on the anterior knee pain scale and worst pain in the past week, with a number needed to treat of 2, are reported as point estimates to inform future trial planning, not as confirmed treatment effects. With such a small sample, these differences should be read as exploratory signals rather than evidence that gait retraining outperforms orthoses in practice. The abstract does not report formal statistical significance testing for the between-group comparison, nor does it clarify long-term outcomes beyond 12 weeks.

Three participants in the gait retraining arm reported minor calf muscle soreness, while the orthoses group had none reported, information relevant to patient counselling but not generalisable given the trial's size. A fully powered trial would be needed before these findings could inform treatment selection.