Biomechanical impact of foot pronation on anterior knee pain – case-controlled study

Albert Anand Udhaya Kumar; Vinodhkumar Ramalingam; Charbel D Moussallem; Kumaraguruparan  Gopal

doi:10.15391/prrht.2025-10(1).05

Authors

Albert Anand Udhaya Kumar Physiotherapy Team Lead, Mediclinic Al Noor Hospital, Abu Dhabi, UAE https://orcid.org/0000-0001-6990-4604
Vinodhkumar Ramalingam Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, India https://orcid.org/0000-0002-5269-0520
Charbel D Moussallem Head of Orthopedic Surgery and Neurosurgery Department, Mediclinic Al Noor Hospital, Abu Dhabi, UAE https://orcid.org/0000-0002-4942-0343
Kumaraguruparan Gopal College of Health Sciences, Gulf Medical University, Ajman, 4184, UAE https://orcid.org/0000-0002-3552-5494

DOI:

https://doi.org/10.15391/prrht.2025-10(1).05

Keywords:

Pronated foot, anterior knee pain, Kujala score, foot posture, musculoskeletal health risk

Abstract

Purpose. The purpose of the study was to investigate the biomechanical difference and relationship between pronated foot posture and AKP in the Abu Dhabi region. Structural abnormalities of the foot can disrupt the normal lower extremity biomechanics, leading to abnormal kinematics and affecting the musculoskeletal health of individuals with anterior knee pain(AKP). In-depth research on the biomechanical link between tibial kinematics and pronated foot posture is crucial for clinical interventions.

Methodology. Involving 50 participants clinically diagnosed with AKP with or without pronated feet. The Kujala patellofemoral score for functional limitations, the foot posture index (FPI) for foot posture, and the dynamic valgus index (DVI) for the knee valgus angle were used as outcome measures. The studies were conducted in compliance with the requirements of the Helsinki Declaration of the World Medical Association "Ethical principles for medical research involving human subjects". A case-controlled study was conducted at a tertiary Hospital, in Abu Dhabi, UAE. The significance was set at p<0.05.

Results. Participants in the case group AKP with pronated feet (mean: 50.20±5.28) had statistically significant (p <0.001) lower Kujala scores as compared to the control group participants with neutral and supinated feet (mean: 83.90± 8.36). In addition, the correlation (p = 0.04) between the variables DVI and FPI was found to cause the altered foot pronation position that led to AKP.

Conclusions. The study findings indicated that the unusual loading among AKP participants on their patellofemoral joint may be influenced by the pronated foot. While managing the participants with AKP, musculoskeletal practitioners should consider foot posture, especially pronation, while evaluating individuals with AKP.

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