Patient Resources

Understanding is everything

Like any problem, any health condition needs to be properly understood in order to be improved.

With the wealth of information available online it can be easy to feel confused and overwhelmed about what’s right for you. Here you’ll find not only relevant information about orthotics and biomechanics but also common misconceptions and myths that I’ll set straight. Anything here that you’d like to discuss or find out more about, please don’t hesitate to get in touch.

Knee pain

The knee joint is easily affected by most foot problems as it is connected to the foot by two vertical bones (Tibia and fibula).

Any lack of support at a foot level will mislead the knee in at least one direction.

What makes this big joint difficult are its two main opposite functions: to provide stability and mobility.

Any lack of foot support must be addressed to avoid knee pain when standing, walking, running, skiing, golfing even riding a bike.

The advice I can give you here depends on your own personal situation.

… walking up and down the stairs/hills

Extended, the knee is in a very stable position, with the heel on the floor, kind of “locked”. With this it’s hard to go wrong unless you suffer from a genu recurvatum where the knee bends backwards (see ‘knee deformity’ below).

Flexed, the knee is in a free position, able to move in any direction. This is where things can go wrong. It’s a dangerous position because you put all your body weight on an “unlocked” knee which relies on tendons and ligaments to remain on track and prevent from more wear and tear when moving.

… when running

Walking can seem easy when you know that you either have one or both feet on the floor and apply only once your body weight. But when it comes to running, you either have one foot on the ground at any given time or you fly. Then when you land again, you apply roughly three times your bodyweight. So, any misalignment at a knee level will cause much more damage when running.

In short, with the knees aligned, running can really help you build a strong body. But if the knees are not misaligned, running can cause a lot of damage.

… when cycling

Cyclists should enjoy having three foundations instead of one. Their hands and bum are sharing their body weight with their feet and they can also use those three points to work on their alignment and performances. Despite this advantage, knee pains remain very common when cycling.

Bike fitting is very helpful, and I recommend it if you cycle a lot and once you have had your feet fitted. Orthotics should come first because they are part of your shoes, part of you and their action massively changes your knee alignment.

Cycling is considered as a “pronation sport”. This is because there is no landing on your feet, but your feet still pronate (rolls inwards) and drag your knee inwards when pushing down the pedal and outwards when pulling up the pedal. In a frontal plan, your knee is making a figure ‘8’. The more we control this pronation, the narrower this 8 shape will look, and the more forces you will transfer to the pedal.

Remember that PRONATION is your best friend at a foot and knee level as this movement helps to absorb the shocks. OVER-PRONATION, on the other hand, must be controlled as it misaligns your body. When cycling, as you do not land, you don’t have much use of this natural shock absorber (pronation). The shoes are rigid and the job of the orthotics is to spread the pressures on the entire sole of the foot while keeping the knee aligned and reducing the waste of kinetic energy (the energy your body possesses due to its motion).

Checkpoint

Depending on the location of your knee pain when cycling, start by checking the following point before consulting a professional.

Pain at the front of the knee: Make sure the saddle is not too low.

Pain at the back of the knee: Make sure the saddle is not too high.

Pain on the medial side of the knee: Make sure you wear your orthotics as the feet point outwards when pronating and the cleats will force and lock your feet in a straight and unnatural position, the medial compartment of your knee will be the first to suffer.

Knee alignment

Frontal plan:

The middle of the kneecap must ideally be aligned with the second toe (the foot axis) for the knee to be considered aligned. In terms of the whole body, make sure that the second toe, ankle, knee, hip and same side shoulder are aligned when you balance on one foot and bend few times the carrying knee.

Sagittal plan:

In an upright position, we can draw one line from the head to the feet to observe where the centre of gravity of the patient goes. At a knee level, the line must pass slightly behind the knee and then in front of the ankle. This keeps us upright thanks to the muscle tone but without demanding any muscle strength from the quadriceps and the calf’s muscle.

Knee deformity

Frontal plan:

Genu Valgum: The knee points inwards (aka “Knock-knee”)

Genu Varum: The knee points outwards (aka “Bow-leggedness”)

Sagittal plan:

Genu Recurvatum: The knee bends backwards. I.e.; Hyperextension of the back knee, often due to a hyperlaxity where loose ligament does not hold and secure the knee properly when standing up. Common in women.