Patellofemoral Pain Syndrome
Refers to a continuum of damage to the cartilage undersurface of the patella – changes vary from mild irritation to macroscopic damage – the later used to be referred to as chondromalacia patellae.
abnormal biomechanics – excessive foot pronation; increased Q angle; ‘squinting patellae’ (from anteversion of femoral neck) – the ‘miserable malignment syndrome’. McClay & Manal (1998) found that the knee of those that foot was pronated had a greater amount of knee flexion could increase patella compressive forces.
abnormal tracking and/or anatomy of patella
muscle weakness – vastus medialis (especially imbalance between medial and lateral quadriceps)
activity – distance running; hill running
Usually a diffuse and vague ache of insidious onset localised to the anterior knee – increases with prolonged sitting or activity – pain may be medial, lateral or infrapatellar – may be aggravated by hills.
May be able to reproduce pain with a squat or climbing stairs
Swelling – either none or slight. Occasionally get crepitus.
May have vastus medialis weakness.
Differential diagnosis – patellar tendonitis, meniscal lesions, plica syndrome, osteoarthritis, fat pad inflammation, Sinding-Larsen-Johansson syndrome.
Activity modification; reduction of pain and inflammation; strapping to correct patellar position (McConnell strapping); strengthening of vastus medialis; correction of foot biomechanics
Surgery – lateral retinacular release
Role of Foot Orthoses: