KNEE PAIN SECONDARY TO ABNORMAL GAIT

AUGUSTINE A. BOLLO, DPM

Knee pain can occur in any age group ranging from childhood to adulthood. Abnormal alignment of the feet and legs is a common cause of knee pain, which begins in early childhood and progresses throughout adulthood, especially when not detected or not treated appropriately. This abnormal alignment may progress to other musculoskeletal conditions, especially in active adults, which may lead to hip and lower back pain, musculature tightness, joint fractures, foot and ankle pain and ultimate osteoarthritis of the knees and/or hips. This type of knee pain usually begins during the increase of walking or exercise activity, which can progress and worsen with daily ambulation.

Symptoms: Symptoms can begin in late childhood or in the early adolescent stage when children become more active in sports and usually complain of early fatigue or tiredness in the legs, soreness inside the knees and sometimes pain in the ankles which are usually better with rest or inactivity. Other symptoms such as muscle cramps and inability to run without difficulty may occur. Similar symptoms recur in adults in addition to hip and lower back pain and/or stiffness. Early symptoms in adults usually occur with running or exercise activity or after standing for a long period of time.

Signs:

  •  Often excessive pronation in feet (excessive joint motion in the foot causing abnormal inward position of the ankles and feet).

  • Flatfeet.
  • Lower extremity tightness (hips, hamstrings and calves).
  • Tender to the inside knees.
  • May have tenderness to the outside of the hip, thigh, lower back and/or inside of ankles.
  • Early fatigue to the lower extremity with increase in walking or running type activities.
  • Shin splints.
  • Arthritis in advanced cases (knees, hips and/or feet).

Treatment:

    1. Appropriate orthopedic evaluation of knees to rule out ligament instability or rule out ligament cartilage or tendon injuries.
    2. X-rays of knees, ankles and feet depending on areas of pain and/or deformity.
    3. Functional orthotic devices (very important). Functional orthotic devices in appropriately positioning the feet with standing and in ambulation in order to realign the lower extremities, which includes the knees, hips and lower back. Orthotics are very beneficial in children and with sport-type activities. They are even helpful in relieving stress to arthritic joints in the lower extremities.
    4. Physical therapy: Appropriate modalities to relieve acute pain in addition to a home stretching and strengthening program.
    5. Shoe modification: A variety of types of shoes are very helpful depending on one’s musculoskeletal condition and particular activity (i.e. sports, workplace). Avoid barefoot walking and flexible flat type shoes.
    6. Modification of activity (i.e. cross training).

In conclusion, there are a variety of reasons one experiences knee pain. Abnormal alignment of the lower extremities is very common in all age groups. Treatment consists of identifying:

    1. The cause of the knee pain.
    2. Treating the acute or chronic symptoms of the knee pain.
    3. Appropriate functional orthotic device to realign the lower extremity.
    4. Proper stretching and strengthening program.