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Now a knee prob with PF!

Posted by Adrienne on 6/22/01 at 16:00 (051274)

Hello all.
I have not really posted much, but I have been a faithful reader on this very helpful site since about February.
Anyway, I've had bilateral PF since Oct 99. Been thru the whole gamut - rest, heat, ice, PT, splints, orthotics, stretching, magnets, taping, ESWT. (no surgery and no shots though) At week 7 of ESWT I started seeing an acupuncturist. She has been great. I was still having level 9 and 10 of pain and after her visit was brought to a 4.

Anyway, at my latest visit - she noticed that my patellas of each knee are in a more inward position than normal, concluding that the tightness in my calves/hams have pulled them in while walking. The right knee is worse than the left, as my right foot is worse than my left. My knees have been hurting recently, but I thought this was because of all the crawling I do around the house. I think she is more correct.
She suggested more stretches than the amount I already do every few hours.

My questions are this: with the amount of stretching I already do plus do more, will my knee caps stop moving? Is there like a brace I should be wearing? any other kind of doc that should be looking at this (currently I would consider Dr. Z as my pod).

I love acupuncture, but she said it takes care of the pain aspect, not what is causing it which are definitely mechanical probs (the tightness, etc).
If anyone has any insight - that would greatly be appreciated!

Adrienne

Re: Now a knee prob with PF!

bg cped on 6/22/01 at 22:10 (051301)

It sounds like you have a typical condition found more in women condromalacia or subluxing patella e.g. your knee caps dont track straight. I have seen many ladies treated with stretching,strengthening, and release surg. I think it is more a condition of the alignment of your legs and foot function. many times it is aggravated by genu valgum (knock knees) and pronated feet.

If you stand in front of a mirror in shorts barefoot. Keep your feet about 5 inch apart and relax your legs and butt muscles. If your knees are almost touching or are and your feet are far apart you can see that the increased q angle from your hips to your knees to your feet.

There are patella stabilizer braces and orthotics with a good motion control running shoe should help if this is the problem. Accupunture may reduce some pain but you need to address the cause of it.

Re: Now a knee prob with PF!

melanie s on 6/22/01 at hrmin (051305)

I have the same prob. Just to let you know...your hips may start to bother you over time as well. The order of mine went: feet, then hips, then knees. It is painful. What I have done to decrease the knee pain is to stay off them (do not crawl around on your knees) and sleep with a pillow between my knees, this keeps the hip angle good and keeps my knees from laying on one another which at times can be painful.. In fact, I bet you have pain in the band that runs from your hip to the knee...to check run you fingers along the sides of you legs on the outside...go from the outside of the hip to the outside of the knee....

Re: Now a knee prob with PF!

Lisa C. on 6/23/01 at 01:34 (051317)

I went to an ortho because my knees also bothered me and my pod doesn't treat above the ankle. The ortho said that I over pronate and that the knees are affected by over pronating. Hips can be involved too, especially in women because of our hips are wider and our legs go in together at the knees. I can't explain it well but he said that the only thing that to do is strengthen the legs, to help compensate and support the knees. He wiggled my knee caps around and said they are actually 'loose'. Doesn't sound good and sometimes upon standing & sitting & walking downstairs or hills it doesn't feel so good either. He sent me to PT to learn how to do the exercises. Hope this helps.
Lisa

Re: Now a knee prob with PF!

bg cped on 6/23/01 at 06:33 (051326)

When I read that you were told that exercise is the only thing I hope you try a good motion control running shoe and at leatst a good otc orthotic if not a custom. My guess would be that 85 percent of the women that get a total knee or hip replacement for non traumatic reasons have knock knees and unstable feet.

Therapy is good but it is hard to overcome gravity and poor bone alignment. I have peobably seen one pt a week with that condition. They come in wearing easy spirits, keds, or some other flexible shoe. They have tried therapy, strengthening, and some have a lateral release procedure. We get them in a good orthotic and sturdy shoe with great results. I cant tell you how many times I have heard 'why didnt they tell me this before' It is a very simple issue of angles. Stand and look at your knees in the mirror. Roll you arches and feet in and out and see how much the space between your knees changes.

When knees roll inward too much the muscles on the front/outside of your thighs get rather strong. My amateur opinion is that many over pronators clinch their toes and keep tension in the quad muscle to help stabilize feet. When you legs roll inward, your quads are trying to pull them back to where they should be, unfortunatly your patella gets caught in the tug-o-war and gets pulled lateral kind of like a train trying to jump the tracks. Over time this rubbing and grinding can wear out the surface under your patella. If you must work on your knee get some big soft knee pads with plastic covers at sporting goods store.

Sorry about the long post I just get irked because I see so many of these cases where all they were told was to stretch, strengthen or get surg. If you have pronated feet and valgus knee, I can almost promise you that a good motion control running shoe and orthotic will put a bigger dent in the pain than anything you have done.

Re: Now a knee prob with PF! *ATTN*: bg cped

Lisa C. on 6/23/01 at 20:40 (051368)

Thank you so much for taking the time to respond with your post. Please never apologize! The longer the post the better! I appreciate benefitting from your experience and vast knowledge. I have bought 2 pair of Mephistos that the man at the Walkabout shoe store recommended. Birks hurt instantly and he said the heel is slightly elevated & the insole is lined but otherwise they are just like Birks. I also bought a pair of Teva's for the water. I purchased PowerSteps but have not yet decided on what shoe to get to put them in. Would you suggest a brand & model??(please) Would you recommend the blue silk Birkenstock inserts over the PowerSteps? That is what the ortho suggested but I haven't read anything about them on this site. I looked in the mirror, I really don't think that I am knock kneed, at least not the dramatic traditional knock knees that I think of. Maybe the ortho or pod will recommend orthotics, but then I will really have a dilema.. deciding what kind to get and where to go & who to make them!

Re: Now a knee prob with PF! *ATTN*: bg cped

bg cped on 6/23/01 at 21:26 (051371)

The problem is mostly seen in women that have some degree of valgus in knees (knocked). I dont recall seeing many cases where they are bow legged. It may not look like an extreme amount but I would bet there is some. If you stand relaxed barefoot and your ankles are about 5 inch apart and there is less space between your knees then it may be aggravated by your feet.

See if you note that it gets worse or better when wearing certain footwear. Look for a pair of New Balance 853 or 1020 running shoe. If you want a m,ore plain looking shoe the ww 810 is good. I am not a big fan of mephisto shoes unless you have no choice due to work situation. They are ok shoes for supinators but for pronators I ffind them too flexible AND too expensive, usually over $150 a pair. They will allow a pronated flexible foot less support because they are too flexible.

Grab the front and back of the shoe and bend it, then twist it. If it is too flexible it lacks support. Me4phisto are ok and are better than many shoes out there just not for the price. If you have your pt tape your patella once and you note relief than a patella sublux brace may hel. Don Joy makes a nice one called a J- Sleeve. Think if you do a search for DJ ORTHO you may find one.

Re: Now a knee prob with PF! *ATTN*: bg cped

Adrienne on 6/23/01 at 21:49 (051374)

Thanks for all who responded to my post. I did the stand test and my knees definitely point inward, but this was not the case before PF. I have always worn sturdy shoes. I did have custom (hard) orthotics made for me, they were good for about a month, then really became painful. they were made because a pod had said that I tend to walk on the outer edges of my feet and my ankle bobbles a bit when my foot strikes the ground. After ESWT, Dr. Z. supplies you with softer full length insoles where he thought I needed more arch support. With the decreased pain from accupuncture, I am goign to go back to the harder ones. So hopefully that and my New Balance's will be ok, along with constantly stretching my leg muscles.
All I know is that my knees look kinda scary! I hope it doesn't spread to the hips as another poster mentioned!
The pillow between the knees does work at night to help though.
Good luck to all!
A

Re: Now a knee prob with PF! *ATTN*: bg cped

Lisa C. on 6/24/01 at 00:23 (051382)

Thank you for the shoe advice. I am hoping to go to Marine World next week, so I will get on it right away. I do prefer a plain shoe, but I will go with the most beneficial at this point. The Mephisto's are an improvement over my pre PF choices!(don't ask) Could you recommend a slip on sandal for home and one for outside? The Mephisto's did flunk the bend/flex test. I have diagnosed myself as having a flexible foot from Dr. B's posts. I have a high arch w/one leg crossed over the other, but flat when on the floor. Should I go with the Birk's? They made me feel like I was falling backwards. I really felt like the heel was sunken way down and the ball of the foot way up. Anything that feels good from the start & doesn't need breaking in? I have never understood all the terms I read such as valgus... I do grip with my toes when walking. Do I have a valgus foot? Is there a glossary of terms available? I am amazed at the amount of knowledge people have aquired about their conditions. Many thanks again bg cped, for your time and help!

Re: Now a knee prob with PF! *ATTN*: bg cped

bg cped on 6/24/01 at 12:59 (051413)

I would not go with birks that soon. They work great for some. They do have a negative heel which is the same ht as the forefoot. This is supposed to stretch heel cords. If you are not used to them and have pf they may be too rough on your feet . You could try some of the thicker sport sandals. They look like the sole of a running shoe with straps attached, New Balance and the other big athletic shoe companies have them.

Re: Now a knee prob with PF! *ATTN*: bg cped

ellen w on 6/25/01 at 09:02 (051461)

Adrienne,

I've had several different knee problems, along with my foot problems. You need a good evaluation to determine what the exact cause of the pain is -- could be shoes, over-use, a back problem, or the other causes mentioned in the posts above. My last knee problem was something called patella-femoral syndrome. In addition to leg strenghtening and stretching exercises, I was shown how to tape the knee (different problems require different taping strategies)to support it, and my PT did some massage to reposition the knee cap back in place. I can't stress enough the importance of finding a good physical therapist that you trust, and that will work with you. Beverly's experience sounds horrendous; I was lucky to find someone on my first try who believes in small incremental steps and developing a regime that can be done at home. (the other thing I found, unfortunately, is that knee problems take a long time to resolve)
Good luck,
ellen

Re: Now a knee prob with PF! *ATTN*: bg cped

Adrienne on 6/25/01 at 10:50 (051470)

Ellen,
Sound like you do have a good PT! You mentioned I need a good evaluation - any ideas by who? I can go to:
1) my ortho that wasn't a big help and just wanted to cast me
2) a pod - though someone said a pod won't treat above ankle
3) my primary care doctor
4) my PT (though I haven't had PT done since February because we had run out of things to help with the heel pain)
5) a new othro
Thanks in advance if you have any more advice!

Adrienne

Re: Now a knee prob with PF! *ATTN*: bg cped

Julie on 6/25/01 at 11:53 (051474)

Coming to this thread late, as I've been away, I want to second BG's post about orthotics. Over-pronation does cause medial (inside of knee) problems: I've had this myself and it was helped by my first orthotics. Your podiatrist should be able to help you with this.

Re: Now a knee prob with PF!

Andrea R. on 6/25/01 at 11:59 (051476)

Adrienne,

Where do you live? Maybe someone can recommend a good doc or PT in your area.

Re: Now a knee prob with PF!

ellen w on 6/25/01 at 12:11 (051479)

It was a sports medicine doc who made the initial diagnosis, but my pt who spent a lot more time figuring out root cause and a therapy approach. If you live in or around New York City, let me know and I'll give you her address.
ellen

Re: Now a knee prob with PF!

bg cped on 6/22/01 at 22:10 (051301)

It sounds like you have a typical condition found more in women condromalacia or subluxing patella e.g. your knee caps dont track straight. I have seen many ladies treated with stretching,strengthening, and release surg. I think it is more a condition of the alignment of your legs and foot function. many times it is aggravated by genu valgum (knock knees) and pronated feet.

If you stand in front of a mirror in shorts barefoot. Keep your feet about 5 inch apart and relax your legs and butt muscles. If your knees are almost touching or are and your feet are far apart you can see that the increased q angle from your hips to your knees to your feet.

There are patella stabilizer braces and orthotics with a good motion control running shoe should help if this is the problem. Accupunture may reduce some pain but you need to address the cause of it.

Re: Now a knee prob with PF!

melanie s on 6/22/01 at hrmin (051305)

I have the same prob. Just to let you know...your hips may start to bother you over time as well. The order of mine went: feet, then hips, then knees. It is painful. What I have done to decrease the knee pain is to stay off them (do not crawl around on your knees) and sleep with a pillow between my knees, this keeps the hip angle good and keeps my knees from laying on one another which at times can be painful.. In fact, I bet you have pain in the band that runs from your hip to the knee...to check run you fingers along the sides of you legs on the outside...go from the outside of the hip to the outside of the knee....

Re: Now a knee prob with PF!

Lisa C. on 6/23/01 at 01:34 (051317)

I went to an ortho because my knees also bothered me and my pod doesn't treat above the ankle. The ortho said that I over pronate and that the knees are affected by over pronating. Hips can be involved too, especially in women because of our hips are wider and our legs go in together at the knees. I can't explain it well but he said that the only thing that to do is strengthen the legs, to help compensate and support the knees. He wiggled my knee caps around and said they are actually 'loose'. Doesn't sound good and sometimes upon standing & sitting & walking downstairs or hills it doesn't feel so good either. He sent me to PT to learn how to do the exercises. Hope this helps.
Lisa

Re: Now a knee prob with PF!

bg cped on 6/23/01 at 06:33 (051326)

When I read that you were told that exercise is the only thing I hope you try a good motion control running shoe and at leatst a good otc orthotic if not a custom. My guess would be that 85 percent of the women that get a total knee or hip replacement for non traumatic reasons have knock knees and unstable feet.

Therapy is good but it is hard to overcome gravity and poor bone alignment. I have peobably seen one pt a week with that condition. They come in wearing easy spirits, keds, or some other flexible shoe. They have tried therapy, strengthening, and some have a lateral release procedure. We get them in a good orthotic and sturdy shoe with great results. I cant tell you how many times I have heard 'why didnt they tell me this before' It is a very simple issue of angles. Stand and look at your knees in the mirror. Roll you arches and feet in and out and see how much the space between your knees changes.

When knees roll inward too much the muscles on the front/outside of your thighs get rather strong. My amateur opinion is that many over pronators clinch their toes and keep tension in the quad muscle to help stabilize feet. When you legs roll inward, your quads are trying to pull them back to where they should be, unfortunatly your patella gets caught in the tug-o-war and gets pulled lateral kind of like a train trying to jump the tracks. Over time this rubbing and grinding can wear out the surface under your patella. If you must work on your knee get some big soft knee pads with plastic covers at sporting goods store.

Sorry about the long post I just get irked because I see so many of these cases where all they were told was to stretch, strengthen or get surg. If you have pronated feet and valgus knee, I can almost promise you that a good motion control running shoe and orthotic will put a bigger dent in the pain than anything you have done.

Re: Now a knee prob with PF! *ATTN*: bg cped

Lisa C. on 6/23/01 at 20:40 (051368)

Thank you so much for taking the time to respond with your post. Please never apologize! The longer the post the better! I appreciate benefitting from your experience and vast knowledge. I have bought 2 pair of Mephistos that the man at the Walkabout shoe store recommended. Birks hurt instantly and he said the heel is slightly elevated & the insole is lined but otherwise they are just like Birks. I also bought a pair of Teva's for the water. I purchased PowerSteps but have not yet decided on what shoe to get to put them in. Would you suggest a brand & model??(please) Would you recommend the blue silk Birkenstock inserts over the PowerSteps? That is what the ortho suggested but I haven't read anything about them on this site. I looked in the mirror, I really don't think that I am knock kneed, at least not the dramatic traditional knock knees that I think of. Maybe the ortho or pod will recommend orthotics, but then I will really have a dilema.. deciding what kind to get and where to go & who to make them!

Re: Now a knee prob with PF! *ATTN*: bg cped

bg cped on 6/23/01 at 21:26 (051371)

The problem is mostly seen in women that have some degree of valgus in knees (knocked). I dont recall seeing many cases where they are bow legged. It may not look like an extreme amount but I would bet there is some. If you stand relaxed barefoot and your ankles are about 5 inch apart and there is less space between your knees then it may be aggravated by your feet.

See if you note that it gets worse or better when wearing certain footwear. Look for a pair of New Balance 853 or 1020 running shoe. If you want a m,ore plain looking shoe the ww 810 is good. I am not a big fan of mephisto shoes unless you have no choice due to work situation. They are ok shoes for supinators but for pronators I ffind them too flexible AND too expensive, usually over $150 a pair. They will allow a pronated flexible foot less support because they are too flexible.

Grab the front and back of the shoe and bend it, then twist it. If it is too flexible it lacks support. Me4phisto are ok and are better than many shoes out there just not for the price. If you have your pt tape your patella once and you note relief than a patella sublux brace may hel. Don Joy makes a nice one called a J- Sleeve. Think if you do a search for DJ ORTHO you may find one.

Re: Now a knee prob with PF! *ATTN*: bg cped

Adrienne on 6/23/01 at 21:49 (051374)

Thanks for all who responded to my post. I did the stand test and my knees definitely point inward, but this was not the case before PF. I have always worn sturdy shoes. I did have custom (hard) orthotics made for me, they were good for about a month, then really became painful. they were made because a pod had said that I tend to walk on the outer edges of my feet and my ankle bobbles a bit when my foot strikes the ground. After ESWT, Dr. Z. supplies you with softer full length insoles where he thought I needed more arch support. With the decreased pain from accupuncture, I am goign to go back to the harder ones. So hopefully that and my New Balance's will be ok, along with constantly stretching my leg muscles.
All I know is that my knees look kinda scary! I hope it doesn't spread to the hips as another poster mentioned!
The pillow between the knees does work at night to help though.
Good luck to all!
A

Re: Now a knee prob with PF! *ATTN*: bg cped

Lisa C. on 6/24/01 at 00:23 (051382)

Thank you for the shoe advice. I am hoping to go to Marine World next week, so I will get on it right away. I do prefer a plain shoe, but I will go with the most beneficial at this point. The Mephisto's are an improvement over my pre PF choices!(don't ask) Could you recommend a slip on sandal for home and one for outside? The Mephisto's did flunk the bend/flex test. I have diagnosed myself as having a flexible foot from Dr. B's posts. I have a high arch w/one leg crossed over the other, but flat when on the floor. Should I go with the Birk's? They made me feel like I was falling backwards. I really felt like the heel was sunken way down and the ball of the foot way up. Anything that feels good from the start & doesn't need breaking in? I have never understood all the terms I read such as valgus... I do grip with my toes when walking. Do I have a valgus foot? Is there a glossary of terms available? I am amazed at the amount of knowledge people have aquired about their conditions. Many thanks again bg cped, for your time and help!

Re: Now a knee prob with PF! *ATTN*: bg cped

bg cped on 6/24/01 at 12:59 (051413)

I would not go with birks that soon. They work great for some. They do have a negative heel which is the same ht as the forefoot. This is supposed to stretch heel cords. If you are not used to them and have pf they may be too rough on your feet . You could try some of the thicker sport sandals. They look like the sole of a running shoe with straps attached, New Balance and the other big athletic shoe companies have them.

Re: Now a knee prob with PF! *ATTN*: bg cped

ellen w on 6/25/01 at 09:02 (051461)

Adrienne,

I've had several different knee problems, along with my foot problems. You need a good evaluation to determine what the exact cause of the pain is -- could be shoes, over-use, a back problem, or the other causes mentioned in the posts above. My last knee problem was something called patella-femoral syndrome. In addition to leg strenghtening and stretching exercises, I was shown how to tape the knee (different problems require different taping strategies)to support it, and my PT did some massage to reposition the knee cap back in place. I can't stress enough the importance of finding a good physical therapist that you trust, and that will work with you. Beverly's experience sounds horrendous; I was lucky to find someone on my first try who believes in small incremental steps and developing a regime that can be done at home. (the other thing I found, unfortunately, is that knee problems take a long time to resolve)
Good luck,
ellen

Re: Now a knee prob with PF! *ATTN*: bg cped

Adrienne on 6/25/01 at 10:50 (051470)

Ellen,
Sound like you do have a good PT! You mentioned I need a good evaluation - any ideas by who? I can go to:
1) my ortho that wasn't a big help and just wanted to cast me
2) a pod - though someone said a pod won't treat above ankle
3) my primary care doctor
4) my PT (though I haven't had PT done since February because we had run out of things to help with the heel pain)
5) a new othro
Thanks in advance if you have any more advice!

Adrienne

Re: Now a knee prob with PF! *ATTN*: bg cped

Julie on 6/25/01 at 11:53 (051474)

Coming to this thread late, as I've been away, I want to second BG's post about orthotics. Over-pronation does cause medial (inside of knee) problems: I've had this myself and it was helped by my first orthotics. Your podiatrist should be able to help you with this.

Re: Now a knee prob with PF!

Andrea R. on 6/25/01 at 11:59 (051476)

Adrienne,

Where do you live? Maybe someone can recommend a good doc or PT in your area.

Re: Now a knee prob with PF!

ellen w on 6/25/01 at 12:11 (051479)

It was a sports medicine doc who made the initial diagnosis, but my pt who spent a lot more time figuring out root cause and a therapy approach. If you live in or around New York City, let me know and I'll give you her address.
ellen