Douglas A. Ehrenberg

Doctor of Podiatric Medicine

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Knee Pain
Broken heel counters and compressed midsoles will allow your feet to roll inward and pronate excessively.
Knee pain can be from many causes, including trauma and arthritis, but in some cases it can be due to abnormal biomechanics. Anterior knee pain (front of the knee at the knee cap) is often caused by tracking dysfunction of the patella, or knee cap, in its groove on the femur. This abnormal tracking may cause softening of the cartilage on the under-surface of the knee cap where it contacts the thigh bone or femur. This condition is called chondromalacia patella, and it often affects athletes, particularly runners and bicyclists. It is referred to by some as "runners knee". In the early stages of the condition, softening of the cartilage results, but breakdown of the cartilage has yet to occur. If untreated, permanent damage to the cartilage may occur, which involves erosion of the cartilage.

If you think you suffer from chondromalacia patella, the first thing to do stop the activity that caused the pain. Next, inspect your shoe gear and make sure the midsoles and heel counters on your shoes are not broken down. Broken heel counters and compressed midsoles will allow your feet to roll inward and pronate excessively. This motion imparts an internal rotation and inward angling of the leg which effects how the patella tracks on the femur. Once the pain has resolved, the next step is to strengthen your quadriceps muscles, especially the vastus medalis oblique. This is the muscle on the inside of your knee above the knee cap. Straight leg raises and extension exercises that focus on the last 15 degrees of extension are helpful. Leg press machines are good for this. Avoid leg extension machines where you start with your knee flexed at 90 degrees. A physical therapist or certified athletic trainer can show you what is safe. If you have done all the above and you have new shoes, yet you continue to have pain and you over-pronate, orthotics may help.


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