Hi all, this is my first post on the discussion forum.
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I recently had a 62 year old female present to the clinic under the Medicare EPC plan. Her primary concerns were lateral muscle compartment pain & anterior knee pain. Her medical history supplied by her GP included sinusitis, rhinitis, OA/RA - cervical & lumbar spine, depression & anxiety. This lady is quite active as a cleaner, also does gym-work & enjoys lots of walking & keeping active.
The pain occurs almost all the time in both the front of the knee just behind the knee cap & the lateral muscle compartment, namely the peroneals which are quite tender to palpate.
In stance & gait, pes planus foot type with rearfoot valgus is observed. There is significant HK build up @ medial 1st MPJ & IPJ. A functional hallux limitus is also present. Joint motions of the feet are mildly restricted & the patient does not appear to have any ongoing symptoms in her feet, other than general fatigue.
Her current orthotics (about 2-3yrs old, patient wasnt sure) were made by Sidas technology & could be 'flattened' through the MLA area with the pressure of an index finger & provided almost 0% support & correction.
The biomechanics & structures of the feet & lower legs led me to a diagnosis Patello-femoral syndrome (resulting from pes planus/rearfoot valgus/shock/incorrect patella tracking) & peroneal muscle overuse (resulting from pes planus/RF valgus).
Due to the patient's active lifestyle, i put her on a self-myofascial rolling program to treat of the pain in her peroneals.
In an attempt to provide her feet with more support & reduce the overuse of her peroneals, I reinforced the plantar aspect of the MLA area of the orthotic with a dense poron of 10mm thickness then ground it flush with the orthotic. A 3mm medial heel wedge was applied to the heel of the orthotic to bring it to neutral in stance, as the added MLA support was not enough for heel correction.
The hope was to trial this for a short period of 3 weeks then return for possible new custom orthotics if the modifications were of benefit.
I said to the patient to trial this for 3 weeks & return for a review, & that if there were any problems to call or return to the clinic.
Fast forward to the present..... (the patient has NOT returned to the clinic, but has made informal complaints by telephone... it has been 10 weeks since initial appointment)
My patient now has reduced pain in the lateral muscle compartment but shocking medial condyle knee pain, which has been diagnosed by both a physiotherpist & Orthopaedic Surgeon as Osteoarthritis. The physio & Orthopaed have both condemned the orthotic modifications as the cause of this problem. She stressed (via telephone) that this is not the same pain that the patient originally came in seeking treatment for.
Im feeling terrible for this, as i had no idea that there was OA in her knees (as her symptoms seemed too anterior & presented as patello-femoral. The GP's initial Care Plan do not indicate OA in the knees either) & this is hardly the outcome i was seeking.... I have heard of a few articles on how raising the medial column of the foot can exacerbate OA symptoms in the medial knee but cant seem to find them, does anyone know of any? Im also open to other suggestions for future treatment... if she ever comes back that is?
Thanks for your time... St.Roars
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