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Foot/Knee Pain – Where to start?

Jan 12th, 2014

Marina asked The Guru for the following Physiotherapy Advice:

Hi there

Wondering if you might be able to give some advise.

I have had an ongoing problem in my right leg for the last 2 years and have yet to get to the bottom of it… mainly by not knowing quite who to turn to and not having the money. When I’m not exercising too much all the symptoms go away but as soon as I raise training just a little they all come rushing back. I’ve had to duck out of 2 half marathons in the last 2 years due to not feeling fit enough for it due to injury.

Two years ago I ran a half marathon, felt fine during the race, but immediately after it had a shooting pain in the on the right hand side of my foot. I couldn’t really walk for about 2 weeks after and stopped running for about 6 months. I did see a Physio for it and was told it was my a problem with my peroneal tendon. I had some treatments, the pain went away but I never felt like it entirely healed.

Recently I started running again and upped my mileage a bit and all the old problems have come back but now with added knee pain. My knee is swollen after each run and hurts to bend it. Normally it dies down after a day of rest, but always comes back after a run. It doesn’t hurt during the run as long as I’ve had a days rest.

I over pronate and have had orthotics since 2004.

What I don’t know is where to start? Should I go back to my podiatrist and get her look at my orthotics again, or should I see a physio? I know its going to cost me money but I know if I don’t actually deal with this its not going to solve itself and I really want to continue my running. I also do a lot of cycling.

Thanks so much for any advice, this is a great service.

Marina

The Guru Responded:

Hi Marina

It’s really unusual for symptoms, despite intervention of any type continuing UNLESS the cause of the symptoms hasn’t been proper identified.

And I think this is what has happens to you.

Orthotics are not the be all and end all and are not always the cause and in your case may be a symptom of lack of control elsewhere.

Your knee and ankle are also just symptoms – perhaps.

I think you need to be looked at as a whole, and especially what your lower limb control is like – from the pelvis down to your foot. Gait analysis, whilst running is what’s called for.

At a punt your most likely got poor glut control as you can’t control how much your thigh rolls in when you land on it. This rotation and grind through the knee causes it to swell with your foot desperately trying to compensate. The pronates foot type is just a product of what’s been happening above….

Marina Responded:

Thank you for this. So seeing a physio is probably the best start to find out the route of the problem?

The Guru then replied:

I think so, yes. Make sure your Physio has a good rap sheet and can fully explain to you where your symptoms come from – you want the cause rather than just a local diagnosis. …..if they plug a machine into the wall, run!

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