There are several painful
conditions of the knee that may
be caused by problems with your
feet.
The knee joint is one of the
most complex joints in the
body. It is a hinge joint, a
sliding joint and a rotating
joint all at the same time. The
proper and pain-free functioning
of the knee requires near
perfect alignment of the bones,
ligaments and tendons that make
up the knee joint. Pain
in the knee is usually an early
warning sign that something is
wrong with the alignment. It is
important to address these
problems early to avoid serious,
long term problems such as
severe arthritis.
The
improper alignment that causes
knee pain is often the result of
improper alignment of the joints
of the foot and ankle. Let me
give some examples.
Pain
on the inside part of the knee
may be caused by bursitis at the
location where three of the
tendons from the thigh muscles
(sartorius, gracilis and
semitendinosus) come together
and insert into the upper/inner
part of the tibia (bone of the
lower leg). This condition is
known as Pes Anserine bursitis.
Pes Anserine is Latin for “goose
foot”. I suppose it is called
goose foot because these three
tendons coming together look
somewhat like a goose’s foot.
The pain is caused by
inflammation of the bursa
beneath these three tendons. A
bursa is a fluid-filled sac that
is found where tendons and
ligaments rub against bone. The
bursa is designed to prevent the
bone from irritating and
damaging these tendons and
ligaments as the rub back and
forth over the bone. When these
bursa become inflamed this is
known as bursitis. Pes anserine
bursitis is inflammation of the
bursa beneath the three tendons
that form the goose foot. Pes
Anserine bursitis can be caused
by excessive pronation of the
foot. The excessive pronation
(see article on normal foot
motion) causes excessive
stretching of these tendons
which over time results in
inflammation. The treatment and
prevention of this condition
involves an arch support to
prevent excessive foot
pronation.
Pain
on the outside of the knee is
sometimes caused by a condition
known as iliotibial band
syndrome. The iliotibial band
runs from the pelvis down the
outside of the leg and attaches
to the outside part of the
knee. Problems with the foot
together with overuse (such as
running or bicycling) can lead
to inflammation where the
iliotibial band inserts into the
outer knee. There are several
different foot problems that can
cause this inflammation. If the
person is flat-footed
(over-pronatnor) this causes the
tibia (lower leg bone) to
excessively internally rotate.
This increases the stretch on
the iliotibial band and causes
inflammation. On the other hand
if someone has a high-arched
foot, the foot is in a supinated
position (see normal foot
motion) and this too can cause
excessive stretch on the
iliotibial band and
inflammation. These two very
different types of foot problems
result in the same painful
condition (iliotibial band
syndrome). However the two
problems require very different
treatments. In order to correct
the problem it is essential to
determine what exactly is
causing the problem.
Knee
arthritis can be caused or
exacerbated by problems with the
foot. Someone that has
arthritis pain on the part of
knee closest to the midline
(medial compartment) may have a
supinated foot that contributes
to a bow-legged type of stance.
Someone with pain in the lateral
compartment (the outer part of
the knee furthest from the
midline) may be flat-footed, a
hyper-pronator, which leads to a
knock-kneed type of stance.
Through the proper use of a foot
orthotic I believe that we can,
over time, reduce the load on
the painful knee compartment,
reduce the pain and at least
slow down the degeneration of
the cartilage.
Pain
in the center of the knee is
often cause by chondromalacia
patella, also known as
retropatellar (behind the
kneecap) pain syndrome. This is
often seen in someone with
excessive pronation
(flat-feet). As the knee
straightens and bends the
kneecap is supposed to ride
smoothly in a cartilage-lined
groove on the lower end of the
femur (thigh bone). Someone that
is a hyper-pronator has
excessive internal rotation of
the tibia. This excessive
internal rotation changes the
angle that the kneecap rides up
and down in this groove (known
as the Q angle or Quadriceps
angle). Over time this leads to
irritation behind the kneecap
and the retropatellar pain
syndrome. An arch support or
orthotic can be very helpful in
treating this condition.
In
conclusion I have discussed a
few of the common causes of knee
pain that can be relieved or at
least improved through the use
of a simple foot orthotic. The
key to treatment however is
knowing what is causing the
problem in the first place. The
techniques we use for diagnosing
the problem will be discussed in
an upcoming article.
