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runners knee

AUTHOR: Marc Mitnick DPM

REVIEWED BY: Podiatric Medical Review Board

--> runners knee

chondromalacia patellae



WHAT IS RUNNERS KNEE



Runners knee, medically known as chondromalacia patellae is knee pain that actually originates from the foot. Most knee pain is due to an inherent problem within the knee, but this knee problem is caused by overuse of the feet seen primarily in runners. Although rare, I have seen it in people who do a lot of walking as well.

runners knee symptoms

The typical scenario seen in chondromalacia patellae is one where prior to the run or workout there is no knee pain. At some point during the workout the knee will begin to hurt, either just below the knee cap or sometimes on the inside (medial) of the knee. It is interesting to note that in runners knee many times the pain will start at just about the same point in the run.

This pain will continue during the remainder of the run but in many instances the pain can become so bad that the runner is forced to stop. Generally the pain will continue throughout the remainder of the day but usually the pain is gone the next day only to reoccur if the patient starts to run. Keep this description in mind because it generally distinguishes runners knee from other knee problems.

WHAT CAUSES RUNNERS KNEE

True runners knee is caused by a deviation in foot biomechanics (the way the foot functions when walking or running). It is generally caused by a condition known as pronation.

During the gait cycle when the affected foot hits the ground in most people it flattens out somewhat to allow the body to propel over the foot and bring the other foot and leg forward. To better understand the gait cycle, click here. During this flattening out of the arch (pronation) part of the pronatory component is for the lower leg below the knee to internally rotate.

The problem is when there is too much pronation and therefore too much internal rotation of the lower leg, because at some point during this part of the cycle the upper leg has to begin externally rotating, due to the alignment of the hips to the feet. So, you reach a point where the upper leg is externally rotating and the lower leg is over internally rotating.

Below is a picture of what is happening to the left leg of a runner who is over pronating.

runner's knee

As one might easily guess this causes a tremendous twisting pressure at the level of the knee. (The top of the knee is twisting in one direction and the bottom of the knee is twisting in another direction). Excessive pronation will increase the angle of patellae tendon attachment into the top of the lower leg (tibia) from a normal angle of 0-15 degrees to upwards of 30 degrees. This will cause the knee cap (patellae) to become irritated and painful.

TREATING RUNNERS KNEE



Using the description of symptoms previously discussed makes treatment very easy. The best way to treat this condition is to eliminate or dramatically reduce the amount of pronation in the affected foot. It has amazed me over the years how dramatic and immediate the relief is.

orthotics for runners knee

The best way to accomplish this is through the use of orthotics. With the use of an orthotic the excessive pronation is eliminated, the lower leg is no longer internally rotating while the upper leg is attempting to externally rotate and the stress on the knee is no longer present.

running with runners knee

Sometimes if the relief from runners knee is not as a dramatic as described I have my runners supplement their treatment with the following: I recommend one Advil or Motrin or equivalent thirty minutes before their workout. Additionally, I recommend icing the knee for a few minutes before the run and immediately afterward. This helps reduce inflammation, but I consider this a short term solution.

Keep in mind this advice will only help knee pain that is a result of over pronation at the level of the foot. As stated earlier most complaints of knee pain is due to problems within the knee itself such as cartilage degeneration, torn ligaments or bursitis to name a few. Generally, an orthotic will not help any of those conditions and a knee specialist should be consulted.

As long as we are on the subject of knee pain related to foot malfunction there is one other not so common problem seen in the knee that may be related to improper foot function. This is seen in a foot that exhibits too much supination.

In this case the foot acts as a very poor shock absorber and all the shock that the body picks up when the heel hits the ground is sent up through the leg. This can manifest itself as pain in the knee area particularly on the outside (lateral) part of the knee.

The best way to combat this is through the use of a shock absorbing type orthotic. A foot specialist can fit you for one of these. Most of the over the counter orthotics do not do a good job of absorbing shock.

exercises for runners knee

Since this problem is essentially a biomechanical problem where there is too much rotation around the knee joint, as a result of excess pronation, there are no exercises that will eliminate the problem. Exercising the muscles that attach and support the knee will only result in marginal improvement. The only treatment is control of excess pronation, generally through the use of an orthotic.

best shoes for runners knee

There are many running shoes that advertise that they are "anti-pronators" and in theory should reduce pronation and in the process reduce knee pain. It has been my experience that in mild cases of runners knee these shoes may be helpful, but probably not very effective in more severe cases.

REFERENCES

Hospital for Special Surgery

OrthoInfo

Johns Hopkins Medicine


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ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


redithotics





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Fla.
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Judy

(location unknown)
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New York
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Memphis, TN
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Scotland
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J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
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Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

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(location unknown)
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(location unknown)
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Madison, Alabama
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Denison, TX
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Texas
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UK


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Regards,

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Mansfield Ctr, CT


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Placentia, California


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Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


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Pacific Grove, CA


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All the best,

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Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


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Anonymous




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New Zealand


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Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

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Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. https://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

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Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
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M P

South Carolina
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Natalie

unknown location


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Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

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San Clemente, CA


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Pam

location unknown


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Glen

location unknown


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Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




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Poland




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Seattle, WA


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Bonnie

location unknown




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New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




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Chrissy

location unknown




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Tracy

Evansville, IA




Dear Marc

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Russ W.

location unknown




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-Sunny.

location unknown




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Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




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....Keep up what your doing. Your a life saver.

Michelle

Colorado




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annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown



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