‘Recap’ on the knee cap
Knee cap pain, more formally known as patellofemoral pain (PFP), is one of the most common injuries of the knee. It typically presents as an achy pain around or under the knee cap (patella). Symptoms usually come on gradually and are worse with activities that load a bent knee such as running, squatting, jumping, and climbing stairs. You can read up on PFP in more detail in our previous article.
Our Biomechanics, (the way we move) can influence the way we place forces through the knee. A common observation of people with PFP are flatter feet (or what we call pes planus) and knocked knees (genu valgus). We know certain movement patterns at the foot, such as when the heel rolls inwards (rearfoot eversion) can influence forces at the knee. These factors are often influenced by genetics and our anatomy and also strength deficits in the lower limbs. We know most adults with PFP have weakness in their quadriceps and around their hips.
A good Sports Physiotherapist or a Sports Podiatrist is pivotal in the progressive management of PFP. Their management approach may include strengthening, tape, manual therapy and advice on how to modify your training load. However, we need to think about the knee not in isolation, but as part of the lower limb… and this means considering the foot and ankle.
What can a Sports Podiatrist add?
Podiatrists are experts of the foot and ankle and have an astute eye for movement patterns of the lower limb. The strength work from the Physio can help to address this, but sometimes further input is needed. Podiatrists will observe you walking, running, squatting, hopping etc and look for certain movement patterns which may contribute to your knee pain. We will often offer advice on modifying your walking or running style to help reduce forces at the knee. For some patients, we increase running cadence (steps per minute) as it is a recognised method to reduced loading at the anterior knee, thus can reduce pain. It is best to consult with a health professional before modifying your running technique as it an result in other injuries if not done correctly.
Get the foundations right with good footwear!
Podiatrists are self-proclaimed shoe geeks, and we love recommending the correct footwear. In the first instance, our priority is to get people in the right shoes for their activity, foot shape and pain. We provide advice on what footwear features to look for when managing PFP, particularly if foot orthoses are to be considered.
What about foot orthoses?
Foot orthoses are not just a random piece of plastic we put in your shoes! Podiatrists prescribe orthoses for a number of reasons, but their main function is to shift pressure and offload painful structures. In the context of PFP we use orthoses to reduce how quickly the foot rolls in. Slowing down this movement can reduce forces at the knee. There is good quality research to recommended foot orthoses as a management strategy as evidence suggests it can help reduce pain and improve function in patients with PFP.
Before we prescribe, Podiatrists often use taping techniques and padding to mimic the effect of orthoses. This helps us identify if orthoses will be a helpful addition for the patient - as no two patients are the same. If we decide that orthoses would be beneficial, we take a 3D scan, design an individualised prescription and send it off to our specialist manufacturing lab. We fit the new orthoses about two weeks later and monitor patient progress over the next few months.
*Note: Flat feet do not always correlate with injury. Loads of people have flat feet without any issues!
In Summary
Current scientific evidence recommends we use a combined approach in managing PFP. This includes the involvement of Podiatry with the prescription of foot orthoses. So, consider booking with one of our highly experienced Sports Podiatrist who will work with you to get you pain free and moving in the right direction.
Written by Sports Podiatrist Alice Corbett B.Pod, MSc (SEM)
