Patellofemoral Pain Syndrome

Condition

The knee cap (patella) sits within the tendon of the muscles at the front of the thigh (Quadriceps) and forms a joint with the thigh bone (femur). As a result, when the knee bends, the patella glides against the bone. When there is dysfunction, then symptoms can occur either in the soft tissues around the patella or the cartilage on the under surface of the patella can become worn away, predisposing to arthritis.

What causes patella femoral pain syndrome?

Whilst the position of the patella can be abnormal and predispose to dysfunction, or direct trauma can start symptoms, the most common cause is poor biomechanical function (i.e. the way in which your legs move whilst walking and exercising).

Studies have shown that this poor function can either be due to poor control around the hip, poor foot function or a combination of the two.

Whilst standard clinical assessment and video analysis can be revealing, the only effective way to measure the rotations within the leg and foot to accurately diagnose the source of dysfunction is 3D gait analysis.

Will it get worse?

Left un-treated, most musculoskeletal problems deteriorate, eventually causing reduced activity. Whilst rest may allow symptoms to settle, they are likely to re-occur when you return to exercise if you have not addressed the underlying cause.

What are the common symptoms?

• Stiffness or pain underneath or around the patella which may be hard to pinpoint.
• It is generally an ache but there may be sharp pain and there may be clicking or grinding.
• Any activity, in particular running, going up or down stairs and squatting can increase symptoms
• Sitting for a long period with the knee bent can be painful (hence the term cinema goers knee)

How is it recognised?

• Clinical examination and a detailed history allow diagnosis.
• A detailed 3D gait analysis can help to diagnose the contributing factors at the hip or foot.
• When necessary an ultrasound scan or MRI scan can help diagnosis.

What can I do to reduce the pain?

There are several things that you can do to try and relieve your symptoms:

• Rest
• Ice can be of benefit
• Hamstring, quadriceps, calf and ITB stretches can help.
• See a podiatrist

What will Premier Podiatry do?

If simple measures do not reduce your symptoms, there are other options:

• Confirm the diagnosis / arrange any necessary investigations
• Perform a detail 3D gait analysis to diagnose the under lying factors that may contribute to injury.
• Advise appropriate shoes
• Advise exercises
• Consider prescribing orthotics; there is evidence that orthotics can help with symptoms in the short term.
• Arrange a guided steroid injection if necessary.

The way in which your foot loads during walking can place increased stress on the foot and this can be controlled by special shoe inserts (orthotics). Whilst these do not correct the position of your foot, they guide motion to reduce symptoms and the risk of further injury.

In many cases orthotics are only required for a short period of time to help resolve symptoms whilst function is improved with an appropriate rehabilitation plan. Our sophisticated 3D gait analysis allows us to advise patients the length of time they will require orthotics.

Will this cure the problem?

In many cases, the conservative treatments are sufficient to resolve the symptoms. In rare instance, surgery is required.

What will happen if I leave this alone?

It is likely to get worse and affect your ability to exercise.

How can I cure the deformity?

If a proper rehabilitation programme is followed, it is highly likely that this will resolve the problem unless any underlying cartilage damage is severe.