Relação entre a pronação excessiva da articulação subtalar e a ocorrência da síndrome patelofemoral: uma revisão crítica da literatura

Abstract

Knee pain is one of the most common orthopedic complaints in clinical practice, and among them, patellofemoral syndrome (SPF) can be defined as a diffuse pain in the anterior region of the knee, aggravated by activities that increase the forces of Compression at the patellofemoral joint. Excessive pronation of the subtalar joint can generate biomechanical compensations such as greater internal hip rotation, knee valgus, and increased Q angle, which may result in the onset of lower limb pathologies such as SPF. The objective of this study was to perform a critical review of the literature to verify if there is a relationship between SPF and excessive pronation of subtalar. For this, we searched for articles that correlate the two subjects (excessive pronation and SPF) between April and June of 2016 in the databases Scielo, Pubmed, Medline and Lilacs, using the descriptors patellofemoral (patellofemoral), pronation (Pronation), patellofemoral pain (patellofemoral pain), patellofemoral syndrome (patello femoral syndrom), foot pronation. Of the ten studies included in this review, eight found a tendency to relate excessive pronation of the subtalar joint and the occurrence of SPF and two did not support this hypothesis. More specifically, a large part of the articles suggesting this relationship, analyzed characteristics of an pronated foot (eg navicular fall, calcaneal eversion) and did not necessarily assess the movement of pronation. Thus, this absence of studies investigating the movement of Pronation and the SPF made the present revision restrictive and evidences the need for new experimental studies so that this proposition can be, in fact, evaluated. Nevertheless, it is recommended that clinical approaches to prevention and treatment of SPF should not be focused only on the knee joint and the pain site, but in other segments such as hip, ankle and foot. As noted in this review, features of a pronated foot are often found in individuals with SPF, reinforcing the importance of assessing the ankle-foot complex in this pathology.