Knee pain and feet

One of the most common knee problems that I see in clinic is Patella Femoral syndrome; also sometimes know as runner’s knee.

The problem causes pain in the front central portion of the knee usually worse when running or walking up or down hill or going up and down stairs (down particularly). Often there can be pain when sitting with knees bent, which is why the condition is also known as theatre goers knee. Pain comes from behind the kneecap (Patella) where it contacts with the thigh bone (femur).

Prolonged excessive shearing forces between the back of the patella and the front of the femur as the patella no longer tracks nicely between the groves formed by the bottom of the femur.

The problem is usually caused by biomechanical dysfunction, over pull of the lateral quadriceps, excessive pronation or supnation (rolling in or rolling out) of the foot. Overuse in sports or activities which are tough on the knee can also lead to patella femoral syndrome, running, jumping, cycling often exacerbated by biomechanical problems.

This results in inflammation, pain and eventually thinning and softening (Chondromalacia) of the articular cartilage behind the patella and on the femur. The condition can also be secondary to fractures, Osteoarthritis and bony tumours, i.e. changes in the bony structure of the knee.

The problem is usually diagnosed on examination and history, although X-ray and MRI can be useful if the diagnosis is not straightforward.

Treatment can involve any or all of the following, controlling excessive biomechanical dysfunction (pronation or supination) of the feet and legs with either strapping or orthotics, quadriceps strengthening, stretching of posterior muscles of the leg and thigh, and sometimes direct treatment to the knee, laser, icing and anti-inflammatory drugs.

Treatment will depend on the severity and duration of the problem and identification of the underlying causes. Prognosis is full recovery, and a return to normal activities once underlying causes are identified and addressed. I think podiatrists are in a unique position the treat this problem as we are able to address the underlying biomechanical problems to resolve the condition. But then I am a bit biased!

Philip Mann Podiatrist/Chiropodist tel: 686 912 307 or www.footpodiatrist.com

Achilles Tendinitis

I seem to be seeing a lot of Achilles Tendinitis in the clinics at the moment. Also known as Achilles tenosynovitis or Achilles tendinopathy.

This condition causes pain in the back of the heel, worse on and after exercise and often particularly painful on rising in the morning. There may be swelling and thickening of the tendon, it may look like a nodule on the back of the tendon.

There are two main presentations of this condition, Noninsertional Achilles Tendinitis and Insertional Achilles Tendinitis, as the names suggest, insertional is in the part of the tendon which attaches into the bone and noninsertional is in the other part. Sometimes the insertional variety is associated with a bony spur formation at the back of the heel (not to be confused with calcaneal heel spur).

So what causes Achilles Tendinitis?

Well as usual there a number of causes it tends to be an overuse type injury, although tight calf muscle in my experience is always present.

Sudden increase in exercise duration or intensity, insufficient stretching before and after exercise, worn shoes and
over pronation where the foot flattens can all contribute.

The condition is common in runners and also sports which involve jumping but can also affect people who are not sporty at all.

The achilles tendon is the largest tendon in the body and it attaches the calf muscle to the back of the heel. It is used to lift the heel and it stores energy each step to help with the following step although very strong it has to have some elasticity.

When someone gets Achilles Tendinitis there is scarring and degradation of the tendon which causes the tendon to become stiff and inflexible. This increases the possibility of rupture. Due to the poor blood supply to achilles it can take a long time to heal. The literature often says six to twelve months although with good treatment I expect it to be a lot quicker.

Treatment of Achilles Tendinitis involves stretching and strengthening, I find Low level Laser works very well as it increases the blood supply to the area and also reduces the pain and swelling.

Rest and cessation of activities which exacerbate the problem, switching to low impact exercise. Ice and anti inflammatories help.

Addressing footwear and controlling the over pronation with strapping or and orthotic. I tend to favor orthotics with a combined heel raise which control pronation and reduce the velocity of the pull on achilles. In severe cases surgical debridement of the tendon may be required.

As with all overuse/sports type injuries there is no single cause to the problem and therefore no single solution and successful treatment is tailored to the individual’s causes and needs.

Philip Mann Podiatrist/Chiropodist 686912307 www.footpodiatrist.com