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Tuesday, January 3, 2012

Knee Pain: The Role of the Feet

Here is an email I received yesterday and my response. 

Dr. Blake,

I am in a conundrum.  Spend out of pocket to see a podiatrist or spend out
of pocket to see a PT.

I am Flat footed
In 1990, my right knee hyper-bent with 150 lbs of backpack weighing me down
with my right foot stuck in snow as the left foot slipped downward.

Current symptoms:

  - Clicking knee cap
  - Kneeling on carpet, great pain until the knee cap pops into place from
  pressure upwards
  - Grinding knee upon flexing
  - Pain on the inside of the rt knee and lower left quandrant of patella
  - Pain and tightness from right side of knee up to the hip
  - Pain behind my knee at the back (anterior)
  - Extreme pain in knee and hip when rising up from a kneeling position
  - Pain and tightness on the inside of my thigh at the knee
  - Feeling of being swollen in the knee itself
  - Walking in running shoes with support is OK at best
  - Walking in dress type shoes with no support results in pain after 25
  yards or so

  - When I use to take spin classes, the instructor noted an outward or
  inward? movement of my leg/knee and asked me to keep it straight, which I
  could not.

I have sat at a desk for 8hr/day for the last two years ~ the first desk
job in my life and this may be part of the problem.

I am self pay ~ no health insurance.

What would the cost range be for a diagnosis by you, treatment and possibly
How long would it take, should we work together, to know if your regiment
for me is working?
At what point would it be wise to pony up for an MRI?  Do I need one?

I am 53, and until recently, in good shape if not great shape.  I need help!

Best always and Happy New Year!


Robert, Thank you for the email. This is definitely a question about timing of treatments when both can be very helpful.

    With that much knee pain, you are 

really in the immobilization/anti-inflammatory phase. Orthotics would

be part of a restrengthening/return to activity phase. The immobilization is any thing that creates a pain free 

environment, from braces, to shoes, to activity changes, and yes, to orthotics if that is what it takes. 

     I would tend to have a PT cool  your knee down first, and then add orthotics when you are ready to

increase your activity again. Orthotics can play a role when you are

throwing everything in to the treatment arena but the kitchen sink (an approach used with unlimited funding).

Definitely, cool the knee down with PT and Icing. The icing for the knee

must be 30 minutes 3 times a day
. Yes, 30 minutes is normally needed to get deep into the knee. 

    Try to stay away from anti-inflam meds since they can slow bone healing. Get an MRI, around $500 self

pay, if your symptoms plateau (look at it one month at a time).

    Try to create a pain free environment over the next month, which may mean staying in your most stable

shoes. You can also try Sole over the counter Arch Supports (get one of the

soft athletic versions). These are easy to adjust.You have already established a relationship between your feet and

 knees, but see if you can get them calmed down, less fragile, over the next several months. 

 Email again with  other unanswered questions. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.