Vionic Shoes    |    Vionic Group

Patello-Femoral syndrome (Knee pain)

Displacement of the kneecap as it tracks over the femur (patella-femoral syndrome) causes inflammation and pain at the underside of the patella.

Symptoms

The patient complains of a nagging pain beneath or on the sides of the kneecap during activities like walking upstairs or getting out of a car. In addition, a dull ache may occur after sporting activities or getting out of a chair. Also, the patient experiences a crunching or clicking (crepitus) sensation around the kneecap. Sometimes swelling is present.

Biomechanical etiology

Excess internal tibial rotation is directly associated with excessive pronation. Therefore, medial displacement of the patello-femoral path encourages lateral displacement of the patella. The cartilage under the patella will eventually soften, resulting in pain and inflammation under and about the patella, especially with excess loading activities such as running.

The cartilage becomes damaged because the patella is not sliding smoothly over the patello-femoral path. Subsequent wasting of the vastus medialis obliquus (VMO) commonly occurs. In addition, the quadriceps, which are important in proper tracking of the kneecap, may become weakened (or fatigued in athletes), thereby displacing the patella further.

Treatment

Common treatments involve the reduction of pain and balancing of soft tissue structures. However, knee pain commonly associated with excess pronation responds well to foot orthotics. Orthotics effectively replicate the natural footprint and provide a stabilizing angle for the calcaneus. This calcaneal angle reduces calcaneal eversion associated with excess subtalar joint pronation and limits secondary internal tibial rotation.

Additional treatment

  • Ice therapy (15 minutes, 3-4 times per day)
  • Muscle balancing
  • McConnell taping technique

Exercises

  • Strengthening of the quadriceps, especially the VMO
  • Stretching of quadriceps and hamstrings