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"A sharp pain in the knee and a grinding sensation, especially when getting up or walking up stairs".
Knee pain is very common. There a number of different types of knee pain. The one described above is called Chondromalacia of the Patella or Patello-femoral Syndrome.
Chondromalacia is the most form of chronic knee pain. It is a general term that refers to pain occurring between the knee cap (patella) and the underlying thigh bone (femur). Chondromalacia of the Patella causes pain and tenderness in the front of the knee. The pain is worse when you sit for long periods and get up. Or when you climb stairs. Often, people experience a grinding or crunching sensation with this type of knee pain.
There a various causes of knee pain. Usually wear and tear occurs with age and/or overuse (for example in rugby players, tradespeople etc).
Softening of the cartilage beneath the knee cap (Patella) results in small areas of breakdown and pain around the knee. Instead of gliding smoothly over the knee, the knee cap rubs against the thigh bone (Femur) when the knee moves. The changes can range from mild to complete erosion of the cartilage.
Another very common cause of knee pain is over-pronation of the feet. The knee forms the link between the upper and lower leg and is a hinge joint, designed to flex and extend the lower leg, not to rotate it!
However, when the foot rolls inwards (over-pronation), the lower leg is forced to rotate, resulting in bad knee function. This will inevitably lead to wear and tear to the knee joint, causing long-term damage and pain.
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The Effect of Foot Orthoses on Patellofemoral Pain Syndrome (Knee Pain) - Amol Saxena, DPM* and Jack Haddad, DPM* - Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA. Corresponding author: Amol Saxena, DPM, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301. From The Lower Extremity 5(2): 95-102.
In a retrospective review of 102 patients treated for chondromalacia patellae and patellofemoral knee pain syndrome/retropatellar dysplasia (PFPS/RPD), the effectiveness of semiflexible foot orthotics was investigated. The combined disorders were diagnosed in 89.3% of the patients. Subjects were 46 women and 54 men, aged 12 to 87 years (mean, 37.9 years; SD, 15.9), who exhibited excessive forefoot varus or rearfoot varus. The initial screening and clinical diagnosis were based on an examination by an orthopedist. Particular attention was directed to patellar crepitation, patellofemoral malalignment, Q-angle measurements, limitation of range of motion, and knee effusion. Patients were evaluated for the onset and duration of patellofemoral pain and degree of knee joint disease. Semiflexible orthoses for each subject were fabricated, based on a clinical lower extremity biomechanical examination. At their follow-up visit, 76.5% were improved, showing a significant decrease in the level of pain with orthotics intervention (chi-square P < .001). Although multiple treatment modalities are used for these patients, the results suggest that the use of semiflexible orthoses is significant in reducing symptoms of PFPS/RPD. (J Am Podiatr Med Assoc 93(4): 264-271, 2003)
The Role of Foot Orthotics as an Intervention for Patellofemoral Pain (Knee Pain)
Michael T. Gross, PT, PhD1- Judy L. Foxworth, PT, MS, OCS2
Foot orthotics often are prescribed for patients with patellofemoral knee pain. The purpose of this clinical commentary is to review the theoretical and research basis that might support this intervention and to provide our own clinical experience in providing foot orthoses for these patients. Literature is reviewed regarding (1) the effects of foot orthoses on pain and function, (2) the relationship between foot and lower-extremity/patellofemoral joint mechanics, (3) the effects of foot orthoses on lower-extremity mechanics, and (4) the effects of foot orthoses on patellofemoral joint position. The literature and our own clinical experience suggest that patients with patellofemoral pain may benefit from foot orthoses if they also demonstrate signs of excessive foot pronation and/or a lower-extremity alignment profile that includes excessive lower-extremity internal rotation during weight bearing and increased Q angle. The mechanism for foot orthoses having a positive effect on pain and function for these patients may include (1) a reduction in internal rotation of the lower extremity; (2) a reduction in Q angle; (3) reduced laterally-directed soft tissue forces from the patellar tendon, the quadriceps tendon, and the iliotibial band; and (4) reduced patellofemoral contact pressures and altered patellofemoral contact pressure mapping. Foot orthotics may be a valuable adjunct to other intervention strategies for patients who present with the previously stated structural alignment profile. J Orthop Phys Ther 2003;33:661-670.
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