Foot‐Targeted Rehabilitation for Pronation‐Related Anterior Knee Pain: A Two‐Phase Case‐Control Study and Single‐Blind Randomized Controlled Trial of Manual Therapy Versus Neuromuscular Training Each With Augmented Low‐Dye Taping

Background and Purpose The mechanistic rationale for treating the foot in anterior knee pain (AKP) is well established in the biomechanics literature; however, translating it into a clinically actionable evidence‐supported rehabilitation protocol has proven difficult. This investigation pursued two aims: to characterize the functional and biomechanical differences between patients with AKP with and without pronated foot posture, and to compare the short‐term effectiveness of two foot‐targeted physiotherapy regimens, manual therapy with augmented low‐dye taping (MT + ALDT) and neuromuscular training with ALDT (NMT + ALDT), against routine physiotherapy care. Methods A sequential two‐phase design was employed in the outpatient physiotherapy department of Mediclinic Al Noor Hospital, Abu Dhabi, UAE. Phase 1 was a prospective case‐control study ( n = 50; pronated foot, n = 30; neutral/supinated, n = 20). Phase 2 was a single‐blind parallel‐group RCT that randomized 31 participants with confirmed pronation 1:1:1 to MT + ALDT ( n = 11), NMT + ALDT ( n = 10), or routine physiotherapy ( n = 10) across 12 sessions in 4 weeks. Four outcomes were assessed at baseline and post‐intervention: NPRS, Kujala AKPS, FPI‐6, and DVI. Results Phase 1 revealed a 33.7‐point AKPS gap between pronated and neutral/supinated participants (50.20 vs. 83.90; p < 0.001, Mann–Whitney U ) and a significant FPI‐6–DVI association ( χ 2 = 4.22, p = 0.04). In Phase 2, ANCOVA confirmed that both foot‐targeted regimens significantly outperformed routine care on all four outcomes (all p < 0.001), with MT + ALDT demonstrating the greatest improvements. Effect sizes were large ( η 2 = 0.646–0.958; 95% CIs reported in Results) and are treated as preliminary estimates warranting cautious interpretation given the small sample and single‐center setting. Discussion Foot pronation was strongly associated with impaired patellofemoral function, although the cross‐sectional design of Phase 1 precluded causal inference. Both foot‐targeted regimens outperformed routine care, and MT + ALDT demonstrated a stronger clinical profile. The equivalent biomechanical outcomes across both experimental arms were consistent with a contribution from ALDT, but its independent role could not be isolated without a taping‐isolated comparator arm. These preliminary single‐center findings support further investigation of foot posture assessment and distal intervention in AKP pending confirmation in adequately powered multicenter trials. Trial Registration ClinicalTrials.gov identifier: NCT05917080