This randomized controlled trial aims to evaluate the effectiveness of short foot exercises combined with focused hip and knee strengthening on pain, Q-angle, and functional outcomes in female patients with patellofemoral pain syndrome (PFPS). Thirty-eight participants aged 18-45 years will be randomly assigned to either an experimental group (short foot + hip and knee exercises) or a control group (hip and knee exercises only) for a 6-week supervised rehabilitation program.

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal condition characterized by anterior knee pain, particularly prevalent among females due to anatomical and biomechanical factors. Although conventional rehabilitation focuses on hip and quadriceps strengthening, persistent symptoms suggest the involvement of distal biomechanical contributors such as foot pronation and intrinsic foot muscle weakness.

Short Foot Exercise (SFE) targets intrinsic foot musculature, improves medial longitudinal arch stability, and enhances neuromuscular control. This study investigates whether combining SFE with hip and knee strengthening provides superior outcomes compared to conventional rehabilitation alone.

This study is a two-arm parallel randomized controlled trial including 38 female participants aged 18-45 years diagnosed with PFPS. Participants will be randomly allocated into experimental and control groups using a computer-generated sequence with allocation concealment. The intervention will be conducted over 6 weeks, with three supervised sessions per week.

The experimental group will receive short foot exercises along with hip and knee strengthening, while the control group will receive hip and knee strengthening only. Outcome measures including pain (VAS), functional status (Kujala AKPS), and Q-angle will be assessed at baseline and post-intervention.

The study aims to determine whether a combined proximal-distal rehabilitation approach leads to better improvements in pain, alignment, and functional outcomes.

Inclusion Criteria:

Diagnosed cases of patellofemoral pain syndrome confirmed by this protocol.

1. Females aged 18-45 years

2. Anterior or retro patellar knee pain lasting ≥ 6 weeks

3. Pain provoked by at least one PFJ-loading task, including:

   1. squatting,
   2. stair climbing/descending,
   3. running,
   4. prolonged sitting with knees flexed

4. Pain elicited by at least two of four clinical tests;

   1. Pain during isometric quadriceps contraction at 20-30° knee flexion
   2. Pain on palpation of the patellofemoral joint line
   3. Pain during patellar compression
   4. Pain during active resisted knee extension

Exclusion Criteria:

History of patellar instability, including subluxation or dislocation 2. Evidence of tibiofemoral pathology, such as: Ligamentous injuries, meniscal tears, and symptomatic knee effusion.

3. Previous knee surgery within the last 12 months 4. Radiographic or clinical knee osteoarthritis. 5. Neurological disorders or systemic inflammatory diseases that may influence gait or pain perception.

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This study is restricted to female participants aged 18-45 years diagnosed with patellofemoral pain syndrome (PFPS). Females are specifically targeted due to the higher prevalence of PFPS in this population, which is attributed to anatomical and biomechanical factors such as increased Q-angle, wider pelvic structure, and a greater tendency toward dynamic knee valgus. Limiting the age range to 18-45 years ensures inclusion of skeletally mature individuals while minimizing the influence of age-related degenerative changes, such as knee osteoarthritis, that could confound study outcomes.