Orthotics 4 Foot and leg Pain

Runners knee or chondromalacia patellae is a perfect example of pain occurring away from the foot that is the direct result of a foot imbalance.   Having said that, most knee pain is the result of an inherent problem within the knee joint itself.  If you are being treated for a knee problem that is not responding to standard treatment then you should explore the possibility of runners knee.

As the name implies this condition occurs primarily in people who do a lot of running, whether it is running per se or the running associated with most sports.  Typically, what happens is that at some point during running one or both knees will begin to hurt.  Depending on the amount of pain, the athlete may be able to run through the pain, but if too painful, the athlete will be forced to stop running.

chondromalacia patellaeTypically the pain associated with runners knee will linger for the rest of the day, but by the next day the pain is usually gone, only to recur once the person starts running again.

This is the difference between runners knee and an problem within the knee joint itself.  Most pain which is the direct result of knee pathology will hurt most, if not all of the time.  The problem may have started while engaging in an athletic activity, but once it is present, it will continue to hurt regardless of the activity.

So, when you start to see a direct relationship between knee pain and running which then subsides only to return at the next athletic event, chances are you are dealing with runners knee.  Runners knee can occur in any age range.

So what exactly is going on here?  When a foot over pronates or flattens out during the gait cycle (running cycle) this over flattening also causes over internal rotation of the lower leg.  More internal rotation than is considered normal.  At some point in the gait cycle the upper leg will begin to externally rotate and in an ideal world the lower leg will also begin to externally rotate and thus the knee joint moves in one direction.

When the upper leg begins to externally rotate and the lower leg is still internally rotating, what happens at the level of the knee.  Basically, the knee is getting torqued.  The top portion of the joint is moving in one direction while the bottom portion is moving in the opposite direction.  The ligaments, including the patellae ligaments end up getting twisted from the torquing motion and you end up with knee pain.

Furthermore, because of the abnormal alignment, there ends up being a jamming on the outside of the knee with stretching of the structures on the inside of the knee.

Yes, of course this same abnormal motion in the knee occurs during normal walking, but in running it becomes exacerbated plus the additional shock of the heel hitting the ground and sending shock up to the knee joint further worsens this situation.

                     how does an orthotic help runners knee?

Once again if we can properly balance the foot and essentially bring the ground up to the foot, so that the foot does not have to over flatten to hit the ground, we are able to reduce pronation.  Reducing pronation then reduces the excessive internal rotation occurring in the lower leg.  Reducing the extra internal rotation then allows the lower leg and upper leg to first internally rotate together and then externally rotate together.  This immediately reduces the strain on the knee joint and its ligaments.

The key here is to adequately control excess pronation.  In these cases most of the arch supports you purchase in stores will be useless as once again most of them attempt to cushion rather than actually support the foot.  An orthotic is needed that will support the arch and not allow it to collapse while running.  It is safe to say, the greater the pronation in an individual, more than likely the greater the pain from chondromalacia patellae and the more supportive the orthotic needs to be.

I find in these cases most athletes who come to me with these symptoms have tried some store bought arch support and have had little to no success, so initially when I tell them that they have runners knee and need an orthotic, they tend to look at me a degree of skepticism.

For this medical problem most runners will do very well in a medical grade off the shelf running orthotic.  Some with exceptionally flat feet and poor shock absorption will need a prescription orthotic and the orthotic will need external posting to further reduce the pronation and help absorb some of the shock of heel strike.

It is worth mentioning here that on more than one occaison I have seen runners knee develop in a runner whose running shoes have just plain worn out.  A running shoe in good conditiion gave them enough support that the foot functioned in a fairly normal fashion but when the shoe wore down the pain began.  So, look at your running shoes first.

As with most medical conditons discussed on this site, this is not the only way to treat runners knee, but I have to say, from my experience using an orthotic to control pronation results in the most impressive improvement.


store bought arch support usually not much help unless you can find an orthotic that will support the arch. Usually will not work with a high arch foot.

medical grade off the shelf orthotic should use a running orthotic. Depending on amount of pain the orthotic may have to be built up for more arch support in those individuals who do not get full relief.

prescription orthotic because the pain is occurring away from the foot, maximum foot control should yield maximum knee pain relief, which can only be obtained in this type of device.

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