Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome refers to a multifactorial pathogenesis that leads to anterior knee pain, most often triggered by increased stress on the patellofemoral joint or cartilaginous lesions on the patella or distal femur.

Rothermich et al. in their study on patellofemoral pain outline malalignment of the lower extremity, muscular imbalance around the hip and knee joints and overactivity as some of the causative factors that contribute to the development of anterior knee pain.

Structural malalignments such as hypoplasia of the trochlea, which plays a critical role in stabilising the osseous patella, can lead to the onset of a number of pathologic abnormalities in the form of patellar malalignment that eventually causes chondromalacia patellae.

Patellar maltracking resulting from muscular imbalances such as a loss of muscle volume and strength in the quadriceps, particularly the vastus medialis obliquus (VMO) muscle can cause lateral displacement of the patella which, in turn, places pressure on the lateral facet.

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An increased Q-angle is also commonly associated with anterior knee pain because of the change in location of contact and pressure in the patellafemoral joint  creating excessive stress and pain in the region.

Hyperpronation of the feet leads to an increase in the Q-angle, causing a dynamic abduction moment at the knee and a consequent increase in the laterally directed force on the patella.

Hervé Collado and Michael Fredericson, from the Stanford University School of Medicine, mention hyperpronation as a causative factor in their study on patellofemoral pain syndrome.

The authors explained that an increase in pronation causes the tibia to internally rotate during the weight acceptance phase of gait, which prevents the tibia from fully externally rotating during midstance.

This prevents the knee from fully locking and causes the femur to compensate by internally rotating in order to allow the knee to fully lock; this increases contact pressure between the patella and the lateral trochlear groove, which increases subchondral bone stress and symptoms of patellofemoral pain syndrome.

Prolonged exposure to the resultant excessive forces created by the ineffectiveness of the foot function combined with the aberrant tracking of the knee, can produce chronic inflammation and joint degeneration, which manifests in the form of patellofemoral pain.

A well-positioned calcaneus, with its anterior facet parallel to the ground at heel strike, allows for an optimal medial arch at mid-stance and full range of motion of the hallux at toe-off.

This is at the heart of MASS4D® Integrated Multi-Axial Posture Theory™ which supports that all articulations work well within their natural ranges of motion while maintaining full functionality in the foot.

With scientific researchers having established a direct correlation between arch height and kinetics, the skilfully produced orthotics at MASS4D® are calibrated considering all these aspects of the foot anatomy, aiming to achieve optimal amounts of functionality in the joints.

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Related Links 
Malalignment Syndrome
The Role of Orthotics in Treating Chondromalacia Patellae
A Review of Integrated Multi-Axial Posture Theory™

References:

1. Rothermich, M. A., Glaviano, N. R., Li, J., Hart, J. M. (2015) Patellofemoral Pain. Clinics in Sports Medicine: April 2015, Vol. 34, No. 2., pp. 313-327. DOI: 10.1016/j.csm.2014.12.011
2. Collado, H., Fredericson, M. (2010) Patellofemoral Pain Syndrome. Clinics in Sports Medicine: July 2010, Vol. 29, No. 3, pp. 379-398. doi:10.1016/j.csm.2010.03.012
3. Waryasz, G. R., McDermott, A. Y. (2008) Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic Medicine: February 2008, Vol. 7, No. 1. DOI: 10.1186/1476-5918-7-9 

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