Motion control Shoes + Internal Tibial Torsion = Knee Pain

Thinking about putting a motion control shoe under that foot to control pronation? You had better make sure you make friends with the knee, as it will often (depending on the compensation) be placed OUTSIDE the SAGGITAL PLANE. Like Dr Allen has said many times before , the knee is basically a hinge joint placed between 2 ball and socket joints, and it is usually the one to start grumbling...

Learn more as Dr Ivo Waerlop of The Gait Guys explains in this brief video

#gait #Gaitanalysis #gaitguys #thegaitguys #kneepain #motioncontrolshoes #internaltibialtorsion

https://vimeo.com/154496722

The Pitfalls of Motion Control Features.

Welcome to Monday, folks. Today Dr Ivo discusses why not all shoes are created equal and why you need to understand and educate your peeps about shoes!

Internal tibial torsion is when the foot is rotated internally with respect to the tibia. When the foot is straight (like when you are walking, because the brain will not let you walk too internally rotated because you will trip and fall), the knee will rotated OUTSIDE the saggital plane (knee points out). Putting a medially posted shoe on that foot rotates the foot EVEN FURTHER laterally. Since the knee is a hinge joint, this can spell disaster for the meniscus.

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Got Motion Control? Sometimes too much of a good thing is a bad thing!

Welcome to Monday and News You can Use, Folks.

Today we look at short video showing what someone with internal tibial torsion looks like in a medially posted (ie motion control) running shoe. Note how the amount of internal rotation of the lower leg decreases when the shoe is removed and when he runs. Be careful what shoes you recommend, as a shoe like this is likely to cause damage down the road.

You can follow along listening to Dr Ivo’s commentary. This was filmed at a recent seminar he was teaching.

L sided medial knee pain in a TKR patient

So, why does this gals L knee hurt, posterior and medial on the left?

• L total knee replacement 6 years ago; she thinks they used too large a size, we would have to agree.
• occassional peripatellar discomfort
• current pain descending hills and stairs, posterior and medial on the left

Physical findings

• tenderness at posterior, medial aspect of knee at the top of the tibial plateau
• positive anterior and posterior drawer +2
• McMurrays for clicking with valgus and varus stresses
• negative valgus/varus stress
• all muscles test strong except for one, which one is it?

Read on…

Here is our theory:

This particular muscle fires at heel strike and again from loading response until toe off (you can look at the diagram above if needed). It also acts as an acessory posterior cruciate ligament (PCL).

Think about the forces on the knee while descending hills or stairs. The momentum will carry the femur forward (or anteriorly). There needs to be something to reststrain this; enter the PCL.

Because of the laxity (and instability), the poplitues needs to fire to take up the slack. Palpation confirmed it being tender throughout its course, with most at the tibial attachment. The attachment is largest here, so that makes sense. The muscle also tested weak.

We gave her popliteus and 1 leg balancing exercises in addition to doing acupuncture (origin/insertion work) as pictured. 5 days later she was 60% improved. She may need to return to her ortho, depending on her response to additional care.

Think about the popliteus the next time someone has posterior medial knee pain, especially when descending.