What’s Runner’s Knee?

Posted by on Tuesday, April 23rd, 2013

Do you have pain behind the kneecap? Does it hurt to squat, kneel, run, sit, or bend your knee? Is it difficult for you to walk downhill or downstairs? Is there a popping or grinding in your knee? How about noticeable swelling? These are the symptoms of a medical condition known as patellofemoral pain syndrome — or, more colloquially, as “runner’s knee.”

What Is Runner’s Knee?

A closer inspection through a CT scan, x-ray, or MRI will help the doctor rule out other conditions and reveal internal damage to the knee. Sometimes doctors will find a tear in the meniscus, bursitis, bone or cartilage contusion, tendinopathy (a disease of the tendons), or a stress fracture instead.

If you have runner’s knee, then the pain you are feeling is the base of the femur gliding across the patella (knee cap). Usually, a smooth layer of cartilage protects you from feeling this routine movement, but some individuals soften and wear down the cartilage through injury or intense physical activity, causing the joint lining to become painfully irritated.

What Causes Runner’s Knee?

“Pinpointing a single cause of runner’s knee is difficult,” explains Runner’s World. “It could be a biomechanical problem—the patella may be larger on the outside than it is on the inside, it may sit too high in the femoral groove, or it may dislocate easily. Also, worn cartilage in the knee joint reduces shock absorption, high-arched feet provide less cushioning, and flat feet or knees that turn in or out excessively can pull the patella sideways.” Furthermore, tightened calves and hamstrings, weakened quadriceps, or even just the repetitive force of movement can trigger symptoms.

How Is Runner’s Knee Treated?

The American Academy of Orthopedic Surgeons recommends the RICE treatment for runner’s knee:

  • Rest: Take a load off! If you must do something, switch to swimming, which is easy on the joints.
  • Ice: Apply cold packs for a short duration, several times a day.
  • Compression: Use an elastic band that fits snugly over the knee.
  • Elevation: Keep the knee resting above the heart as often as you can.

Pain relief through ibuprofen or aspirin is also recommended to manage the symptoms. Stretching is also important therapy. If these home care treatments do not ease your suffering, you will need to see a doctor.

How Can A Podiatrist Help?

A podiatrist can fit you with custom orthotics to correct your gait. A 2003 study found that more than 76 percent of patients with runner’s knee saw “a significant decrease in the level of pain” and the disappearance of symptoms after receiving custom orthotics. It should also be noted that these particular patients did not respond to other treatments.

Dr. Stephen M. Pribut DPM, a past President of the American Academy of Podiatric Sports Medicine, explains how the orthotics work to alleviate pain in greater detail: “Orthotics limit the maximum amount of excessive pronation. They also have been demonstrated to reduce the speed (acceleration) of internal tibial rotation. Reducing the speed of internal tibial rotation will reduce the amount of sudden stresses applied to the undersurface of the patella and the need for the VMO ( vastus medialis ) to work so hard in maintaining proper tracking and positioning of the patella. As per Newton’s Laws slower motions will require less force to counterbalance them.”

A podiatrist can also conduct a gait analysis to find out if your running or walking is contributing to the condition. If you need help learning how to wrap the knee properly, stretch, or perform regular exercises that strengthen weak muscles, our NYC Center for Podiatric Care and Sports Medicine can help!

Removing Toenails for Ultramarathoners: Helpful or Crazy?

Posted by on Wednesday, April 10th, 2013

Last week I wrote about toenails: why they exist, how they help us in our modern lives, and why they thicken as we age. While toenails may not be as indispensable as they once were – as rough horn-like projections that protected our toes from all sorts of environmental hazards – they still help protect our toe bones and give us something to paint in festive colors. But one group of extreme athletes are saying goodbye to their trusty little nails. And it’s all in the interest of greater efficiency, less pain, and better overall performance. But toenails are a body part! Are these people totally insane? When you consider all of the maladies of those innocuous-seeming little hardened keratin plates, maybe not.

Advice for the First Time Runner: Start with Your Feet

Posted by on Wednesday, March 27th, 2013

For some reason, I tend to assume a lot of you readers are already runners. I think it’s my own bias: years of running have warped my mind. These days I imagine the world is made up of runners and non-runners, and never the twain shall meet. This is, of course, ridiculous. There are probably thousands of novice runners hitting the streets every day with excitement and hope in their hearts. We all have to start sometime, right? So today’s post is for you: the newbie! Welcome to the wonderful world of running for pleasure, health, vitality, and energy. It may not always feel great (there’s nothing quite so painful as mile 5 when you’ve only ever run 3) but it’s always rewarding. The feeling of accomplishment I have after a particularly challenging run is what I live for. It keeps me going. It makes me feel strong, capable, and great about myself. You’ve made a choice to do something that can be incredibly healthy for your body and mind, congratulations! Now here’s how to do it safely.

It’s Toe Clever: The New Topo Running Hoof Shoe

Posted by on Friday, February 15th, 2013

Several years ago the running world was rocked by the Vibram FiveFinger shoe: footwear designed to emulate barefoot running. The barefoot controversy notwithstanding, the five-finger shoes saw huge sales. Tony Post, Vibram’s creater and a former professional runner, firmly extolled Vibram’s good qualities, like any good father would. To illustrate the strange appeal of the weird looking FiveFingers: my sister got a pair and she’s not even a runner. She thought the design looked cool paired with a miniskirt. Kids! Well, now Tony Post is up to his old tricks, this time with the Topo, a strange hoofed hybrid that separates the big toe, like a traditional Japanese tabi. Is this just a marketing scheme? Are their any podiatric benefits to Post’s Topos? Is it too soon to tell?


Event Announcement: Aquaphor New York City Triathlon Injury Prevention Webinar

Posted by on Thursday, February 7th, 2013

Tonight from 7-9 PM EST, Dr. Geldwert will be participating in the Aquaphor New York City Triathlon Injury Prevention Webinar. If you will be participating in the triathlon, are a triathlon enthusiast, or just want to learn about protecting your feet while you pound the pavement, you’re invited to tune in!

The Apocalypse is Coming: Preparing Your Feet for the End of the World

Posted by on Friday, December 14th, 2012

If the Mayans were right and the end of the world is just days away (and the Mayans were right about everything, right?) we’re all going to need a plan for making sure our lower extremities are in good working order. After all, when the planes fall from the sky, the highways are jammed with cars, and the trains fly off their tracks in movie-style apocalyptic flames, your feet will be your only salvation. They’ll carry you to safety. They’ll support your weight as you lift a boulder off your loved one. They’ll protect you when nothing else can. That is, if anything can protect a single puny human from God’s great fury. So, while you’re stockpiling emergency rations, fresh water, batteries, and prayers, don’t forget your feet.

9 Easy Ways to Avoid Foot and Ankle Running Injuries

Posted by on Tuesday, November 27th, 2012

If you ask me (and you just did, didn’t you?), running is one of the greatest forms of exercise out there. Why? Well, you basically just need some shoes and you’re ready to go. No trip to the gym, no making sure you signed up for the class you want with the teacher you want, no need to join a league (although many people have a lot of fun with running clubs).  No, just you and the road, the park, or the track at your local high school.

The Surprising Secret to Better Feet: Healthy Big Toes and How to Get Them

Posted by on Thursday, October 25th, 2012

Our big toes may seem little compared to, say, our heads, but they do a huge amount of work. The big toe bears twice as much pressure when walking as the other toes and the big toe joint takes 40-60% of the your body’s weight when maximum force is applied. Your big toe also can have an impressive range of motion–you can pick things up with your big toe, and gymnasts are able to execute some of their more impressive moves thanks to the way they can grip with the digit (I love referring to toes and fingers as digits, don’t you?).

The Long Run, Part I: Preparing Your Feet for a Marathon

Posted by on Monday, October 8th, 2012

With so many people preparing for autumn marathons, I think it’s a good time to take a look at how you can get your feet ready. Yes, your feet–not your diet, conditioning, or hydration schedules. According to the website for the Marathon des Sables, a staggeringly difficult multi-day 150 mile run across the Sahara Desert, carrying a backpack, in 120 degree heat (very useful training if you’re a survivalist or planning a career in counter-terrorism, but pretty much a sign of insanity in anyone else), 90% of people who drop out or visit the medical tent do so because of foot problems. So let’s see how can you make sure that your feet don’t fail you during your nice little 26.2 mile race on civilized paved roads.

Take the Edge Off Your Foot Pain with Peroneal Tendonitis Treatment!

Posted by on Thursday, October 4th, 2012

It’s frustrating when you have pain on the edge of your foot. It seems like people never want to believe you know where it hurts. You describe it and they say, “Oh, pain under your arch in the middle of your foot? That’s plantar fasciitis,” or “Pain on top of your midfoot? Sounds like a foot sprain.” And you just sigh and say, “No, the edge, trust me, I know where it hurts…”

With that in mind, let’s talk about one of those injuries that can occur on the outside edge of your foot: peroneal tendonitis.