Do I need a custom-molded orthotic for patellofemoral pain syndrome? Do the off-the-shelf (ready-to-wear) orthotics work just as well?

Patellofemoral pain syndrome (PFPS) usually presents as pain in the front of the knee or around the patella (kneecap). Pain often gets worse with activities that load the patellofemoral joint such as stair climbing, squatting, or hill running.

Many doctors suggest using over-the-counter arch supports as the first step. Custom-molded orthotics are saved for patients who aren't helped by ready-to-wear supports.

The job of the orthotic is to limit how much the arch falls. Keeping the foot in the middle or neutral position will limit lower leg motion. The result is a decrease in the abnormal motion behind the patella. Some think custom-made orthotics, rather than off-
the-shelf models, give the best pain relief.

However, a recent study of orthotics use in PFPS showed it didn't matter what kind of natural foot position or orthotic is used. The muscles responded the same in all cases. It's possible that just stimulating the bottom of the foot is all that's needed. More studies are needed to find out for sure.