Patellofemoral Pain Syndrome

Patellafemoral pain syndrome is a malalignment of the femur and the patella which is often a result of poor biomechanics of the foot and lower limb.

The patellofemoral joint is the articulation of the patella with the femoral condyles which forms a “groove” known as the femoral trochlea. The patella is the largest sesamoid bone in the body, embedded in the quadriceps and the patella tendons. The patella also acts as a fulcrum for extension of the quadriceps.

Etiology:

The pain experienced with Patellofemoral Pain Syndrome (PFPS) is generally believed to originate from two sources.

  1. Injury to the various soft tissues associated with the patellafemoral joint.
  2. From compressive forces between the patellar facets and the femoral condyles where they articulate which varies the knee position.

 

The Q-Angle is perhaps the most well-known single factor. The Q- Angle is a line created from the anterior iliac spine to the mid patella, which intersects with ta line from the mid-patella to the tibial tubercle when the knee is in full extension. Left Picture  

Females have a larger q-angle primarily due to the their wider hips compared to males which explains why patellofemoral pain syndrome is more prevalent in females.

However, strong clinical evidence suggests that one of the main causes of patellofemoral pain syndrome is the excessive pronation of the feet. Each time the foot pronates, a chain of events occurs upwards in the lower limb. The shin (tibia)  and the knee internally rotates on its axis and increasing the velocity of the pulling movement on the patella/femur connection. 

Management:

Custom foot orthotics work to control the excessive pronation of the subtalar joint in the foot which will in turn limit both the amount and velocity of the internal rotation of the shin (tibia) and the knee.  

Taping is also a good short term solution for PFPS. The taping technique is designed to stabilize and minimize the lateral tracking of the patella. Taping can reduce pain and allow strengthening exercise to begin earlier.However taping is a short term solution and doesn’t address the mechanical problems which caused the condition. Orthotics remains the best long term solution as it corrects the biomechanical alignment of the of the lower limb.