ABSTRACTThis clinical investigation was undertaken to determine whether biomechanical foot orthoses (BFOs) can be used as first‐line treatment of patellofemoral pain syndrome (PFPS) within a family practice/sports medicine office setting. During a 36‐month period from November 1995 through October 1998, those patients meeting the criteria for diagnosis and treatment of PFPS were prescribed BFOs as a first‐line treatment if their knee pain occurred before, during, and after exercise (grade 3 pain) or if their knee pain prevented athletes/patients from participating in any form of exercise (grade 4 pain). Six months after the BFOs were properly fitted, each patient was sent a questionnaire to determine the outcome of treatment. On a scale from 1 (least painful) to 10 (most painful), the weighted average preBFO level of pain was 7.34 and 6 months later the weighted average pain level was 2.46. The overall weighted average knee‐pain reduction was 4.9 (67% across the full range of patients). On the basis of this retrospective investigation, there are firm indications that high‐quality, consistently fabricated BFOs offer athletes/patients a cost‐effective first‐line mode of treatment for PFPS of moderate to severe degree.