A 52-year-old woman presented at Leading Edge Podiatry with pain in the front of her left knee. She reported that the pain had been present for approximately 16 months and had gradually worsened over time. She was otherwise healthy and did not take any medication. She was a recreational runner. Before the injury, she was running between 6-8 km per run 3 times per week.
Patient’s Pain Symptoms
The patient reported that the pain was present in the front of her knee. The onset of pain was when she first noticed a dull ache in her knee after completing a standard 8km run. The pain was initially mild but gradually worsened over time. The patient described the pain as a sharp sensation in the knee. She would often run through the pain; however, it has limited her frequency of running to 1-2 times per week. She would also occasionally get pain when climbing stairs, squatting, and walking longer distances.
Examination and Assessment
The patient’s knee was examined and palpated; the pain was worse when pressing on the front of the knee. There was mild swelling medially of the knee. It was sore at the medial inferior pole of the knee cap. The podiatrist also assessed the patient’s range of motion, strength in the knee joint, and the flexibility of her lower leg and foot muscles, ligaments, and tendons. There was tightness noted in the ITB (outer thigh), hamstrings, and calf. There was hypermobility in the subtalar joint of the foot and ankle. Gait showed severe foot pronation.
Diagnosis and Treatment
The podiatrist diagnosed the patient with patellofemoral pain. The patient was advised to rest from running and standing for prolonged periods and to avoid any other activities that caused pain. The podiatrist recommended a course of physical therapy to stretch and later strengthen the knee muscles. The patient was advised to wear orthotics to support the arch of the foot and to reduce the strain on the knee. The patient was also advised to undergo dry needling to loosen the structures around the knee.
After 6 weeks of treatment, the patient reported a significant reduction in pain and was able to return to running and stand for prolonged periods without discomfort. The patient was advised to continue with the physical therapy exercises and to wear orthotics as directed.
