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Jul 23

Written by: Larry Huppin, DPM
7/23/2009 1:46 PM

I had a patient present yesterday with complaint of a 10 year history of right-only lateral knee pain when running.   Pain would occur on every run after 20 - 30 minutes.   He never went more than 30 minutes without pain occurring.   Biomechanical exam and knee exam were both normal except for a slightly under-pronated foot (RCSP was slightly inverted)   He has had a complete work-up of the knee by an orthopedist and exam was normal.

There is significant literature available to support the use of foot orthoses in the following knee pathologies:
1.  Patello-femoral pain syndrome
2.  Medial knee osteoarthritis and pain
3.  Prevention of ACL injury

There is very little research, however,  that supports the use of orthoses for lateral knee pain.  There is support, however, for the use of laterally wedged orthoses in decreasing load in the medial compartment of the knee  to treat medial knee pain.  Given that, it would be reasonable to think that medially wedged orthoses would decrease load through the lateral compartment.  

This gentleman had traveled 5 hours to see us, so we applied a low-dye taping with a felt varus heel wedge and sent him out for a run.  He came back an hour later.  He had run 40 minutes with no knee pain - the first time he had gone more than 30 minutes in more than a decade. 

His response to the taping and wedging is indicative that medial wedged foot orthoses will also likely decrease his symptoms.  Thus, we casted him for orthoses today.  Here is the prescription:

Although there is little available literature to support the use of orthoses for lateral knee pain, there is also no literature that we know of indicating that they are not helpful and our clinical experience indicates that orthoses can be helpful.  Pre-orthotic taping and wedging can be a very effective test to determine likely outcome.  


1 comments so far...

Re: Foot Orthoses for Lateral Knee Pain

I want to provide an update on this patient. After his break-in, he was able to run with no lateral knee pain at all. He did develop some blistering in the mid-arch on one foot. We simply decreased the varus wedging on that side by about 1 degree. That reduced the pressure that the arch of the orthosis was applying to the arch of his foot and eliminated the problem.

There is an entire blog post on troubleshooting arch blisters. Search for "blisters" to find that post.

By LH1000 on   1/20/2010 8:13 PM

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