Knee pain and how orthotics can help

This description of knee pain is most common and refers to a condition called Patello-femoral Syndrome. Patello-femoral Syndrome is the most common form of chronic knee pain. It refers to pain occurring between the knee cap (the patella) and the underlying thigh bone (the femur). Patello-femoral Syndrome causes pain and tenderness in the front of the knee. The pain gets worse when you sit for a long period and get up. Or when you walk up stairs. Often, one will experience a grinding or crunching sensation in the knee.

Instead of gliding smoothly over the knee, the knee cap grinds against the thigh bone when the knee moves. In turn this may result in heavy erosion of the cartilage. Apart from age and over-use, the third most common cause of knee pain is faulty gait (i.e. the way we walk). Overpronation (=rolling inwards of the feet and lowering of the arches) is a major contributing factor to knee pain.

Over-pronation not only causes bad knee function. An estimated 70% of the population suffers from some degree of over-pronation and this becomes evident in other areas of the body, especially at an older age. People with overpronation can display symptoms such as frequent ankle sprains, pain in the arches, leg pains, shin splints, hip pain, even lower back pain.

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.

Literature is reviewed regarding (1) the effects of foot orthoses on pain and function, the relationship between foot and lower-extremity/patellofemoral joint mechanics, the effects of foot orthoses on lower-extremity mechanics, and 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 a reduction in internal rotation of the lower extremity; a reduction in Q angle; reduced laterally-directed soft tissue forces from the patellar tendon, the quadriceps tendon, and the iliotibial band; and 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.