medial knee pain

medial knee pain

pain and discomfort at medial knee joint area, secondary to strain imposed by excess foot pronation (see Table 1)
Table 1: Biomechanical problems associated with predisposition to overuse knee injury
ProblemCharacteristics
Knee stiffnessThe knee is fully extended at heel strike and should flex easily immediately after heel strike to facilitate the absorption of the shock of heel strike
Knee flexion is facilitated by transverse plane motion where the medial condyle of the distal femur rotates medially on the medial platform of the superior tibia; where transverse plane motion is limited (as in coxa valga/genu varum, coxa vara/genu valgum) knee flexion will be less efficient
Where knee flexion is compromised, increased stress is imposed on its structures
Loss of subtalar joint (STJ) pronationShock absorption is also facilitated by STJ pronation; where STJ pronation is limited (as in hindfoot varus or tibial varum) or where the STJ functions routinely at the limit of its range of motion (such as in an abducted foot ± hallux limitus), greater forces are transmitted to the knee with resultant tissue strain
Structure of the kneeThe collateral ligaments of the knee and the menisci are at greatest risk of injury at the point of maximum foot pronation and knee flexion
Ground reaction force (GRF)STJ pronation and knee flexion are initiated by GRF; GRF increases tibial shearing forces which, combined with femoral rotation, can induce knee injury
Excess foot pronationKnee extension creates a stable support limb during propulsion
During propulsion the pelvis and femur rotate externally, but the weight-bearing tibia cannot rotate externally if the foot is excessively pronated, creating a torque on the knee joint, medial knee strain and patellofemoral pain
Gastrocnemius actionDuring knee extension the gastrocnemius is passively stretched and maximally efficient, allowing transfer of power from the quadriceps to the ankle. Once the knee is flexed, gastrocnemius is relaxed and not efficient, and only soleus contraction effects ankle plantarflexion

Knee injuries may be induced by transverse-plane compensation for structural deformities in the lower leg or foot.

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