The Harding Podiatry practice has treated a number of patients with medial knee pain, usually with great success. Many have been referred by orthopaedic surgeons who want their patients to explore conservative therapy to relieve their symptoms before proceeding to surgery.
These patients experience pain in the medial compartment of the knee that is caused by degenerative changes involving the medial meniscus as well as the articular cartilage on both the medial condyle of the femur and medial plateau of the tibia. There is often a loss of joint space with compression of those surfaces when weight bearing.
The established surgical solution is a partial or full knee joint replacement, however, the patient may be considered too young for this procedure.
Since the cause of most of the pain is a loss of medial compartment space, or compression of the medial compartment, the logical, conservative approach is to place a wedge under the lateral aspect of the foot to create a ‘valgus alignment of the lower leg’, opening up the medial compartment joint space. Although the change in alignment is often too small to measure, the reduction in compression can have a dramatic effect in reducing symptoms.
Unfortunately, this wedge can cause excessive pronation of the foot with associated internal tibial rotation, at a time in gait when the foot should be resupinating with associated external tibial rotation. This creates a torque stress on the medial knee compartment, exacerbating the wear on those joint surfaces.
To effectively open the medial knee compartment without creating excessive foot pronation, the full length lateral, valgus wedge needs to be added to a prescription orthosis that is made from strong material that does not deform when exposed to the forces and load during weight bearing activities and can maintain an efficiently functional foot position. This can then provide excellent relief of medial knee pain.
It is important that the orthosis shell material is rigid, or strong enough, to prevent distortion during weight bearing activities. The use of soft, flexible, often pre-made off-the-shelf orthoses will not be able to control the excessive pronation created by the addition of a lateral, valgus wedge. This will result in accelerated degeneration of the medial knee compartment.
If you are suffering from knee pain of any kind, book an appointment with one of our podiatrists for an assessment.