Rehabilitation Programmes Incorporating Foot–Ankle-Targeted Exercise for Patellofemoral Pain: A Systematic Review and Meta-Analysis

The comparative effectiveness of foot–ankle-targeted exercise within patellofemoral pain (PFP) rehabilitation remains uncertain. We searched seven databases to 17 August 2026 and included 10 independent randomised trials (431 randomised participants; 413 analysed). The protocol was registered in PROSPERO (CRD420261479147). Random-effects meta-analyses prioritised programme-component modifications and active head-to-head comparisons, with mixed treatment contrasts examined exploratorily. Models used restricted maximum likelihood estimation with protected Hartung–Knapp or bias-reduced cluster-robust (CR2) inference. For programme-component modifications, the pain mean difference (MD) was −0.77 points on a 0–10 scale (95% confidence interval [CI] −1.97 to 0.43), the function Hedges’ g was 0.39 (95% CI −0.21 to 1.00), and the frontal-plane knee alignment g was −0.48 (95% CI −1.38 to 0.42). Active head-to-head estimates were MD 0.56 (95% CI −0.25 to 1.38), g −0.03 (95% CI −0.62 to 0.56), and g −0.18 (95% CI −1.07 to 0.71), respectively. Negative effects favoured foot–ankle-inclusive programmes for pain and alignment, whereas positive effects favoured them for function. All confidence intervals included no between-group difference; certainty of evidence was low or very low. Current evidence does not establish clear incremental or comparative benefit; adequately controlled add-on trials are needed.